Phantom Pain: A Research Report on Causes, Mechanisms, and Treatments

This report provides a comprehensive review of phantom pain, a condition where individuals experience pain in a missing body part. The introduction defines phantom pain, also known as phantom limb pain, highlighting its prevalence and the challenges it poses to both patients and physicians. The report explores the mechanisms of phantom pain, examining various perspectives, including the top-down and bottom-up approaches. It discusses the impact of phantom pain on amputees, including challenges related to self-concept, financial changes, and psychosocial adjustments. The report then delves into different treatment methods, such as neurosurgery, electrical stimulation, pharmacological treatment, and psychological management. The conclusion emphasizes the lack of a definitive treatment for phantom pain due to the incomplete understanding of its underlying mechanisms, while also highlighting the need for further research to improve patient outcomes. This research review compiles different perspectives on the causes and various treatment approaches for phantom pain to provide a comprehensive overview of the condition.

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Phantom Pain and its Treatment
Introduction
Phantom pain refers to a condition characterized with actual pain that an individual feels as a
result of a missing body part (Weeks, Anderson-Barnes, & Tsao, 2010). Phantom pain is also
known as phantom limb pain and causes frustrations to both patients and physicians. Phantom
pain is difficult for physician to manage while it causes discomfort to patients (Ahmed,
Mohamed, & Sayed, 2011). High levels of 60%-70% phantom cases are reported after one year
of amputation (Kim, & Kim, 2012). Phantom pain was not recognized until it was defined by
Silas Weir who was a surgeon in civil war (De Ridder, Elgoyhen, Romo, & Langguth, 2011).
The following report is a research review on phantom limb pain and methods that can be used to
treat the condition. This will involve examining various perspectives of phantom pain and
critically reviewing literature on phantom pain and methods that can be used to treat the
condition.
Critical Evaluation of Phantom Pain Mechanism
There are different perspectives that different scholars and physicians use to study phantom pain.
The phantom pain is perceived to be caused by different actors that stimulate mild or severe pain
to a patient. Weeks, Anderson-Barnes, & Tsao, (2010), defined phantom pain as conscious
feeling as a result of a painful limb even after amputation. Kim, & Kim, (2012) on the other side,
defined phantom pain as perceived pain from a region of a body that is no longer present in the
body. The authors noted that nearly all amputees are likely to feel as if their missing limb still
exist that lead to chronic phantom pain. Kumar, & Saha, (2011) also defined phantom pain as an
ongoing painful sensations coming from a limb that is not there. Phantom pain is real despite the
limb being absent and the pain length differs from one person to another. There are two distinct
perspectives to phantom pain; top down and bottom up approach. These approaches have been
hypothesized and put down to theories that enhance rational treatment. The top down perspective
puts forward that phantom pain occurs when sensory inputs are suddenly lost and the patient
brain had no change to adapt. This perspective shows that phantom pain is stimulated by the
brain in the process of adapting to loss of an input. The brain causes pain in the process of

adapting to new change that has happened to the body. The top down perspective therefore
argues that phantom pain can be managed by tricking the brain (Hsu, & Cohen, 2013). On the
other side, the bottom up approach is opposite of top down. The perspective show that phantom
pain resides in nerves in the patient’s spinal cord. The neurons are the ones that carry pain
signals from the body to the spinal code. The spinal cord then sends signals to the brain. The
bottom up perspective shows that pain starts from the area affected with amputation where the
signal is sent to the spinal cord then pain is indicated in the brain. This approach also argues that
phantom pain is not imagined in the patient brain but felt. Therefore there is no single agreed
perspective to phantom pain.
Several studies have been done to explore, explain, and illustrate phantom pain. Amputees have
to face both the stump and phantom pain. The amputees have other several challenges that
include; self concept and self image, financial changes, physical functioning impairment, loss of
independence, adapting to prosthesis use and many psychosocial adjustments. These challenges
stress amputees that cause depression which in some cases lead to contemplation of suicide.
Despite phantom pain having large impact to amputees, it has proven difficult to standardize it
clinical management and assure patients’ quality health care (Kumar, & Saha, 2011). Kumar, &
Saha, (2011), in their study established that phantom pain is both caused by peripheral and
central mechanism. The changes in peripheral and central mechanisms following an amputation
were found to be involved in phantom pain. Phantom pain was found to be frequent where the
amputees had long-term stump pain (Mulvey, Bagnall, Johnson, & Marchant, 2010). Mulvey et
al., (2010) established that phantom pain was correlated to stump temperatures. Lower
temperature in stump show reduced near-surface blood flow which is correlated to burning
symptoms of phantom pain. De Ridder et al., (2011), found that pressure sensitive neuromas
exacerbated phantom pain. In another research, Flor (2014), found that there was neuropathic
stump pain to 61% of patients with phantom pain and only 39% without phantom limb pain.
Central mechanisms play a role in sensitization of dorsal horn stimulates phantom pain. An
increase in peripheral nociceptors activities lead to permanent change in synaptic structure. This
change leads to reduced inhibitory processes and then lead to increase in excitability making
neurons prone to fire effected causing persistent phantom pain. Flor, (2014) concluded that both
central and peripheral aspects have a role in causing phantom pain. Phantom pain is therefore
caused by peripheral and central mechanisms.

Methods of treating Phantom Pain
Phantom pain has high prevalence and is difficult to manage. Several studies have outlined
several methods of treating phantom pain. There are several suggestions in surgical, medicinal,
and conventional therapeutic approaches that reduce phantom pain. The phantom pain treatment
examples that reduce pain include; stump manipulations, sympathectomy, nerve blocks,
pharmacologic therapies, stump ultrasound, cordotomy, myoeletric prosthesis, and
transcutaneous nerve stimulation (Subedi, & Grossberg, 2011). Subedi & Grossberg (2011)
noted that these approaches were only slightly effective that meant their application was not
satisfactory to treat phantom limb pain.
Phantom pain has six main treatment methods; neurosurgery, electrical stimulation, biofeedback
treatment, pharmacological treatment, psychological management and dorsal column
stimulation. The nervous system is highly associated with phantom pain. The surgeons apply
neurosurgery method to treat phantom pain by destroying nervous system that connect the
peripheral and cerebral hemisphere with an objective of reducing phantom pain. Wolff et al.,
(2011) found that neurosurgery as method of phantom pain treatment is a temporary means to
relief pain and the method has an inherent risk of patient permanent neurological incapacity.
Secondly, electrical stimulation method of phantom pain treatment stimulates peripheral nerves
that lack sensory stimuli following amputation. The methodology increase stimuli that increase
inhibitory effects in the brain decreasing hyperactive neural mechanisms that cause pain. Hsu &
Cohen, (2013) found that electrical stimulation method has 50% success rate. In another
research, Flor, (2014), assessed twenty patients and 7 were found to have gotten excellent relief
and 3 obtained partial relief. Only 2 patients did not obtain any pain relief. He concluded that
electrical stimulation was an effective method of treating phantom pain because of it high
percentage of success. Thirdly, the dorsal column stimulation method of treating phantom pain is
designed similar to electrical stimulation except that it used for stimulating the dorsal columns of
spinal cord rather than peripheral nerves. Ahmed, Mohamed, & Sayed, (2011) in their research
on 5 phantom pain patients found that the treatment was successful and results sustained for
more than two years. The fourth method of treating phantom pain is pharmacological treatment.
Patients are treated with Lysergic Acid Diethylamide (LSD-25) drug that increase
neurotransmitter serotonin. The serotonins are central to pain modulation and their deficiency
can lead to increased pain sensitivity stimuli. The methodology therefore administers LSD-25

that increases levels of serotonin. This helps reduce phantom pain. Flor, (2014), found that LSD-
25 improved patients’ condition by reducing pain. However, Flor, (2014), concluded that LSD-
25 drug is a non hallucinogenic dose and therefore has psychic reaction, addictive and distorts
perceptions that make it ineffective method of treating phantom pain. The other method of
treating phantom pain is biofeedback treatment. This method is based on peripheral and
psychologic theories and it approach is based on anxiety-muscle tension-pain cycle. The
biofeedback system contracts patient’s muscles to make them audible using electrodes. The
patient then learns how to relax musculature and the pain in peripheral nerves is relieved. Lastly,
phantom pain is treated using psychological management method that is based on three-phased
strategy. The first phase is prevention, second phase is intervention and the last phase is
behavioural and psychotherapy therapies. Woolf, (2011) argue that pain personalities pose are
difficult to treat and require behavioural and psychotherapy therapies to remove the pain.
Therefore, there is no one agreed method of phantom pain treatment.
Conclusion
From the research review, phantom pain is a common condition among amputees. The phantom
pain is ongoing and cause discomfort to the patients and is difficult for physicians to manage.
Despite several studies on phantom pain, there is no agreed mechanism to the cause and
treatment of the condition. The two common perspectives are top down and bottom up
approaches of phantom pain. The top down perspective show that phantom pain starts from the
brain as a result of amputation. On the other side, bottom up approach show that phantom pain
start from the amputated areas to the spinal cord that is then connected to the brain. Phantom
pain can be treated using several methods that include electrical stimulation, dorsal column
stimulation, neurosurgery, pharmacological treatment, biofeedback treatment, and psychological
management. Therefore, it can be concluded that there is no definitive treatment that can cure
phantom pain because it cause mechanism is still unknown.

References
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