Phantom Pain: Causes, Treatment, and Management

This article discusses phantom pain, a condition where individuals feel pain in a limb that is no longer there. It explores the causes, pathophysiology, treatment options including medications and medical therapies, and potential future treatments. It also provides information on lifestyle and home remedies for managing phantom pain.

Running Head: PP 0
Phantom pain
Student Name
5/14/2019

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Contents
Introduction.................................................................................................................................................2
Pathophysiology......................................................................................................................................2
Treatment options...................................................................................................................................3
Medications.........................................................................................................................................3
Medical therapies................................................................................................................................4
Surgery................................................................................................................................................5
Potential future treatment......................................................................................................................6
Lifestyle and home medications..............................................................................................................6
Conclusion...................................................................................................................................................7
References...................................................................................................................................................8

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Introduction
Phantom pain (PP) is the pain that sense like it is coming from the body which not
actually there. Previously it was recognized as the psychological issues and believed as post-
amputation phenomenon, but specialists no identified that there actual sensations produced in the
patient’s spinal cord and brain (Nikolajsen, & Christensen, 2015). Many individuals who
recently had a limb detached, occasionally, feels like the removed limb is still on its place. Thus
painless situation, called phantom limb sensation, however it is not similar to phantom pain. In
the United States, nearly 30000 to 40000 amputations are performed every year, and 95 per cent
of the patient reported to have amputation-related pain, 79.9 per cent experience phantom pain
and 67.7 per cent reported residual limb pain (Johnson, Mulvey, & Bagnall, 2015). In this
particular assessment report, the phantom pain and its treatment methods will be discussed.
The phantom pain sensations are actually the perceptions that a person experiences
associated with the limb or organ. Symptoms associated with these health issues are onset inside
the first week of amputation, pain that arises and goes and remains pain that might be identified
as shooting, stabbing issues, continues cramping, pins, and needles (Nikolajsen, & Christensen,
2015). The exact cause of this problem is not clear; however, it seems to arise from the patient's
spinal-cord and the brain. Some specialists believed that his type of pain might be occurring as a
reaction to the diverse signals comes from the mind. Some of the risk aspects of phantom pain
comprise the pain before the amputation, and the residual limb pain (Richardson, & Kulkarni,
2017).
Pathophysiology

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The neurological foundation and mechanisms for the phantom limb discomfort are
completely derived from the experimental philosophies and examinations. There is little
information related to the true mechanisms causing this type of pain, and numerous theories
extremely overlap. Previously PP was thought to be occurring from the neuromas situated at the
stump tip (Johnson, Mulvey, & Bagnall, 2015). The traumatic neuromas, or the non-tumour
nerve injuries, commonly arise from the surgeries and outcomes from the abdominal
development of impaired or injured nerve fibres. However stump neuromas involved in phantom
pain, but are not considered as lone cause, as the patient with the deficiency of congenital limb
sometimes experiences phantom pain. This indicates that there is the main depiction of the limb
accountable for the painful feelings (Nikolajsen, & Christensen, 2015).
Treatment options
Medications
Though no medications exist particularly for PP, certain drugs prepared to treat other
situations have been supportive in releasing nerve pain. The physician might need to attempt
dissimilar medication to find which one works for the specific patient (Ambron, Miller,
Kuchenbecker, Buxbaum, & Coslett, 2018).
Medicines used in the management of phantom pain comprise:
Over the counter or OTC type of pain reducers like Acetaminophen (example; Tylenol),
ibuprofen (example; Advil, Motrin IB) and naproxen sodium can be used to release phantom
pain. The patient should take these medicines only as recommended by the physician.
Overconsumption can cause severe adverse effects, like stomach bleeding (Johnson, Mulvey, &

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Bagnall, 2015). Antidepressants like Tricyclic-antidepressants might release the pain occurred
due to impaired nerves. Examples comprise tramadol amitriptyline, and nortriptyline (Pamelor).
Potential opposing effects comprise sleeplessness, and blurry visualization. Anticonvulsants;
Epilepsy medications like gabapentin (example Gralise), and the pregabalin (example Lyrica)
might be prescribed to manage nerve aching. Adverse effects might comprise unsteadiness,
drowsiness and mood alterations (Petersen, Nanivadekar, Chandrasekaran, & Fisher, 2019).
Narcotics; Opioid medicines, including codeine and morphine, might be a choice for certain
individuals. Taken in suitable doses according to the doctor's direction, they might help to treat
phantom pain, although these drugs are prohibited in some areas. Though, a patient might not be
capable to use them if they have a past of substance abuse (Lendaro et al., 2018). These
medicines can cause several side effects, comprising constipation, sedation, nausea, or vomiting.
Other drugs like N-methyl-d-aspartate or NMDA type of receptor antagonists can also be
provided. These anesthetics work by attaching to the NMDA receptors present on the pstient’s
nerve cells of the brain and hindering the action of glutamate, a protein which plays a major role
in communicating nerve indications. In different readings, ketamine and dextromethorphan are
sued as NMDA receptor antagonists’ releasing phantom pain. Adverse effects of the ketamine
comprise mild drowsiness, illusions or loss of awareness. Although there are no adverse effects
were identified from dextromethorphan use (Dunn, Yeo, Moghaddampour, Chau, & Humbert,
2017).
Medical treatments

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As with medicines, handling phantom pain with the noninvasive treatments is depend on
trial and diagnosis. The subsequent techniques might release phantom pain for certain
individuals:
Mirror box; A particular device comprises mirrors that sort it appear like a removed limb
presents. The device has two different beginnings, one specific for the complete limb and other
on is for the remaining limb. The individual then implements regular workouts, while viewing
the movement of the whole limb and visualizing that patient is really sensing the absent limb
movement (Lendaro, Hermansson, Burger, Van der Sluis, McGuire, Pilch, & Gudmundson,
2018). Certain readings, however not all, have established that this particular exercise might help
reduce phantom pain or discomfort. Acupuncture; The Nationwide Institutes of Wellbeing has
established that acupuncture might ease certain kinds of continuing pain. In this method, the
physician inserts enormously fine, pasteurized needles into the patient’s skin at the precise
points. This therapy is usually recognized safe when completed properly (Finn, et a., 2017).
Repetitive transcranial magnetic stimulation (rTMS); this particularly therapy applies an
electromagnetic coil located against the patient’s forehead. After this, small pulses are delivered
by the coil that produces minor electrical currents in the patient’s nerves situated in a specially
targeted part of his or her brain (Kuffler, 2018). Investigation recommends that this treatment
might be supportive of phantom pain; however, it is not yet exactly accepted for this complaint.
The magnetic field is comparable to the one applied in MRI tests. Adverse effects might
comprise a minor headache or dizziness. Spinal cord stimulus; the clinician introduces minute
electrodes alongside the patient’s spinal cord. A minor electrical current brought constantly to
patient’s spinal cord can occasionally release pain (Luo, & Anderson, 2016).

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Surgery
Surgery might be a choice if other management has not helped out. Operating choices
include: Stimulation of Brain; this approach and the motor cortex stimulus are related to spinal-
cord stimulus excluding that the current is transported inside patient’s brain. A physician applies
a magnetic resonance imaging (MRI) image to locate the electrodes properly. Though the
information is still restricted and these managements are not precisely accepted for the phantom
pain, this approach seems to be a favourable option for selected patients (Bornemann-Cimenti,
Dorn, & Rumpold-Seitlinger, 2017).
Possible future management
Newer methods to release phantom pain comprise virtual reality spectacles. The
computerized program for the specs mirrors the individual's complete limb; therefore it appears
like amputation is not there. The individual then changes his or her virtual limb nearby to
achieve numerous activities, like striking away a ball dangling in air. Though this method has
been verified only on a minor number of individuals, it seems to assist in releasing PP (Lendaro
et al., 2018).
Lifestyle and home medications
The patient might not have regulation over whether he or she develop PP after the
operation, however, they can reduce their discomfort and increase the quality of life
(Bornemann-Cimenti, Dorn, & Rumpold-Seitlinger, 2017). Some of the approaches can be
implemented in Phantom pain are; Distractions; discovering actions that take patient’s
concentration off the pain, for example reading or music listening. Physical activity; It has been

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recognized that some of doing exercises such as gardening, cycling walking or swimming can
distract the patient. Taking medicines properly; the patient should follow the doctor's instructions
in taking recommended pain pills. If they try to use alternative herbal medication they must
discuss with the physician (Kuffler, 2018). Relaxation; the patient should Practice some activities
that decrease the patient's tension associated with emotions and muscles. They should take a
warm bath which must not be too hot as heat might worsen the pain. Some of the relaxation
procedures like rhythmic breathing, meditation or imagine can be introduced. They should also
seek help from other individuals. Remember that management of phantom pain can change the
way patient feel their pain. If one method does not deliver relief from pain, the patient should try
something else, rather than giving up (Aiyer, Barkin, Bhatia, & Gungor, 2017).
Conclusion
Phantom pain is actually the pain that feels like it is appearing from the patient's body
that is longer there. Among all the 30000 to 40000 amputations, nearly 79.9 per cent experience
phantom pain. Symptoms associated with PP include onset inside the first week of amputation,
the pain felt as stabbing, shooting, needles, and pins. Some of the treatment can be used in
phantom pain include medicinal (antidepressants, OTC, Anticonvulsants, Narcotics, and
NMDA), medical therapies (mirror box, acupuncture, rTMS, and Spinal cord stimulation),
surgeries, and lifestyle-related changes.

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References
Aiyer, R., Barkin, R. L., Bhatia, A., & Gungor, S. (2017). A systematic review on the treatment
of phantom limb pain with spinal cord stimulation. Pain management, 7(1), 59-69.
Ambron, E., Miller, A., Kuchenbecker, K. J., Buxbaum, L. J., & Coslett, H. (2018). Immersive
low-cost virtual reality treatment for phantom limb pain: Evidence from two
cases. Frontiers in neurology, 9, 67.
Bornemann-Cimenti, H., Dorn, C., & Rumpold-Seitlinger, G. (2017). Early Onset and Treatment
of Phantom Limb Pain Following Surgical Amputation. Pain Medicine, 18(12), 2510-
2512.
Dunn, J., Yeo, E., Moghaddampour, P., Chau, B., & Humbert, S. (2017). Virtual and augmented
reality in the treatment of phantom limb pain: a literature
review. NeuroRehabilitation, 40(4), 595-601.
Finn, S. B., Perry, B. N., Clasing, J. E., Walters, L. S., Jarzombek, S. L., Curran, S., & Pasquina,
P. F. (2017). A randomized, controlled trial of mirror therapy for upper extremity
phantom limb pain in male amputees. Frontiers in Neurology, 8, 267.
Johnson, M. I., Mulvey, M. R., & Bagnall, A. M. (2015). Transcutaneous electrical nerve
stimulation (TENS) for phantom pain and stump pain following amputation in
adults. Cochrane Database of Systematic Reviews, (8).
Kuffler, D. P. (2018). Coping with phantom limb pain. Molecular neurobiology, 55(1), 70-84.

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Lendaro, E., Hermansson, L., Burger, H., Van der Sluis, C. K., McGuire, B. E., Pilch, M., &
Gudmundson, L. (2018). Phantom motor execution as a treatment for phantom limb pain:
protocol of an international, double-blind, randomised controlled clinical trial. BMJ
open, 8(7), e021039.
Luo, Y., & Anderson, T. A. (2016). Phantom limb pain: a review. International anesthesiology
clinics, 54(2), 121-139.
Nikolajsen, L., & Christensen, K. F. (2015). Phantom limb pain. In Nerves and Nerve
Injuries (pp. 23-34). Academic Press.
Petersen, B. A., Nanivadekar, A. C., Chandrasekaran, S., & Fisher, L. E. (2019). Phantom limb
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nerve, 59(2), 154-167.
Richardson, C., & Kulkarni, J. (2017). A review of the management of phantom limb pain:
challenges and solutions. Journal of pain research, 10, 1861.