Understanding Phantom Limb Pain: Causes, Symptoms, and Treatment

This article discusses the concept of phantom limb pain, its prevalence, and the different theories that explain its occurrence. It also explores the different pharmacological and non-pharmacological approaches for treating phantom limb pain.

Running head: PSYCHOLOGY
Psychology
Name of the Student
Name of the University
Author note

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Introduction
The notion of Phantom pain or the Phantom limb pain refers to the sensations that are
perceived as pain that is experienced by an individual associating with an organ or a limb
which may not be a physical part of the body (Hanson 2016). This idea has been defined first
by Ambrose Pare who was a military surgeon in France in the sixteenth century. Later the
term ‘phantom limb pain’ has been coined by Silas Weir Mitchell and he had provided a
widespread definition of the situation. However, the concept of phantom pain is still poorly
understood in the medical science, therefore in many cases it is complicated to treat. A recent
study exhibits that approximately 1.6 million patients with a loss of limb has been projected
and some scholars indicate that the numbers may rise to 3.6 million by the year 2050
(Schipper and Maurer 2017). The phantom sensation is generally a sensory phenomenon that
can be felt at the absent part of the limb or the entire limb. The past researches have indicated
that approximately 80% amputees tend to experience the phantom sensations during some
point of their lives. In fact some of the patients tend to experience a little phantom pain and
feel the missing limb throughout their lives. Therefore this paper will target the depictions of
phantom pain and will discuss the methods that can be utilized for treating it.
Discussion
Resources suggest that the Phantom limb sensation and Phantom Limb pain both are
interlinked but it needs to be differentiated from the other. The Phantom limb sensations are
mostly experienced by those people who have an injury in the spinal cord or have a
deficiency in congenital limb deficiency whereas the Phantom Limb pain tends to occur only
as an outcome of an amputation (Chien and Bolash 2017). Some of the recent reports show
that the prevalence of Phantom Limb pain is more common amongst the ones having upper
Limb amputation than the ones having lower Limb amputation. Even though some of the

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researchers think that Gender and age make no difference in such experience of pain the
previous reports have shown that Phantom Limb pain 3 to be more common amongst the
female patients than the males. Even a recent survey has reported that overall pain
interference and intensity is greater in the female patients than the males and it is also
observed that women significantly endorsed great catastrophizing usage of few strategies for
coping with the pain and believes that are associated to many aspects of the pain which may
result in to poor adjustments.
There are several reports about Phantom pain and Phantom sensations after the
amputation of the body parts such as Strong Teeth breast bladder eyes nose but Phantom
meaning after leave application is most common amongst all. Throbbing, tingling, piercing
and needle sensation are the most common pain that has been reported. Recent study has also
revealed that there is a chance of a strong association between the residual limb pain and the
Phantom Limb pain which may trigger anxiety, stress or depression and other emotional
disturbances as well (Khan and Braun 2015). At the initial stage Phantom leaving pain has
been considered as a psychiatric illness. However with the evidences from numbers of studies
dating place over the past few decades the idea of Phantom pain has been shifted towards the
neural axis. There are hypothesis is charges Central neural mechanism and peripheral
mechanism that has gained immense population as the potential mechanism for defining
Phantom Limb pain (Goldberg 2016). How is none of these theories are capable of explaining
the phenomenon independently therefore most of the theorists believe that there are numbers
of mechanism then to be responsible for the occurrence of Phantom Limb pain.
There are numbers therapies that are relied on different theories which has
been proposed for treating Phantom Limb pain. However according to many theories
particular guidelines for treating Phantom Limb pain are yet to be evolved. There are three

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specific approaches for treating Phantom Limb pain such as pharmacotherapy invasive or
surgical procedures and adjuvant therapy.
Over the years researchers have developed few pharmacological approaches for
treating this pain. Anaesthesia and pre-emptive and a Glacier is a major approach for treating
Phantom Limb pain. It is believed that pre-emptive usage of and aesthetics and analgesics in
the preoperative period can prevent the stimulus from the particular imputed please from
triggering the central neural sensation and other hyperplasic changes that may prevent future
impulses to be amplified from that amputation site. Recent research has reported that
following controlled and a Glacier optimised epidural anaesthesia within 48 hours of the
amputation tend to decrease Phantom Limb pain. After years of studying the researchers have
also settled on specific medications that can be used for treating Phantom Limb pain. A
recent cross sectional research has indicated that NSAID and acetaminophen at the most
common medications. Is Indore the analgesic mechanism of the lateral wall is not really clear
but it is said that different central nervous system ways such as serotonergic tend to be
involved here. The former one is believed to be in Hayward the specific enzymes which are
required for synthesizing prostaglandin and decreasing nociception centrally and peripherally.
Opioids are another renowned method for binding to the central and peripheral Opioid
receptors therefore providing analgesia without losing consciousness proprioception or touch
(Ortiz-Catalan et al. 2014). These can also diminish the reorganization of cortical therefore it
can disrupt one of the potential mechanisms of Phantom Limb pain. For the past decade both
controlled and random trials have revealed the call treating any neuropathic pain like
Phantom Limb pain. According to Foell et al. (2014) tri-cyclic antidepressants is a commonly
utilised medication for different neuropathic pain that was it is also used for treating Phantom
Limb pain. The analgesic reaction of this anti depression is attributed mostly to the
inhibitions of the serotonin norepinephrine uptake blockages. As stated by Raffin et al.

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(2016) the tri-cyclic antidepressant is already established for treating several conditions of
neuropathic pain, but its reaction for treating phantom limb pain has been mixed. A recent
research on the usage of antidepressants reveals that an average dosage of 55mg of
amitrypline can control phantom limb pain in an excellent way. There are other
pharmacological approaches for treating this pain such as anticonvulsants, Calcitonin or
NMDA receptor antagonism. Both the results of Calcitonin and Anticonvulsant treatments
have received mixed outcomes for controlling phantom limb pain (Vaso et al. 2014).
Previous researches also report that the NMDA receptor antagonism is also unable to provide
a clear mechanism for the pain. Some have shown remarkable benefits in some of the cases,
whereas the controlled trial has exhibited mixed outcomes.
However the non-pharmacological treatments are also quite popular including
Transcutaneous Electrical Nerve Stimulation, Integrative, bio-feedback, behavioural
methods, mirror therapy, electroconvulsive therapy etc. According to Philip et al. (2017)
Transcutaneous Electrical Nerve Stimulation (TENS) has always been helpful in PLP
treatment. There have been several studies exhibiting its effectiveness. Even thought there is
still no strong evidences, both high frequency and low frequency TENS are effective for
treating PLP than any other methods. The devices for TENS are easily portable; however this
therapy has some contradictions as well. Another well-known therapy for treating PLP is
Mirror therapy which focuses on determining the visual-proprioceptive dissociation of the
brain. In this therapy, the patient sees his or her reflection of their undamaged limb shifting in
mirror that is placed between their legs or arms while shifting the phantom foot or hand in a
way similar to their observation so that the phantom limb can be replaced by the virtual limb.
Several studies have shown the existing mirror neurons can trigger both the times when an
action is performed or observed. Random or controlled mirror therapy has been applied on
patients who have amputation in their lower leg have exhibited that here is a significant

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benefit of this therapy as the activated mirror neurons can block the pain awareness within
the phantom limb (Foell et al. 2014). On the other hand, even though there have been reports
stating that the behavioural methods are helpful in treating the PLP, but there has not been
any specific evidence of matching a specific behavioural and bio-feedback techniques
matching to a particular type of PLP. However several neurotic pains tend to be treated with
the help of hypnosis, relaxation techniques and guided imageries, therefore some case studies
have shown that these cognitive behavioural therapies are effectual in treating PLP as well.
Ambron et al. (2018) suggest that if no other treatment method is successful, surgical
interventions can be employed. Some case studies also reveal that stimulating spinal cord can
be helpful for patients who are not being able to obtain sufficient relief with medical
procedures.
Conclusion
PLP is a comparatively common entity in the medical arena and psychology.
However, there is still no such merging theory that can define the PLP mechanisms. Some
treatments based on PLP mechanisms are still developing, however most PLP treatments are
still done on the basis of specific suggestions for the neuropathic pains. Therefore it can be
said that a combining hypothesis clarifying this phenomenon is still evolving for elucidating
the connected between phantom limb pain and the proposed mechanisms.

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