Phantom Limb Pain: Treatment, Cost and Side Effects

Some people may have undergone limb amputation, which is a process of removing either parts of the limb such as foot, hand, arm, leg, toe or finger or entire limb as a part of surgical treatment. Most common type of amputation is the one above or below the knee. The main reason for the amputation is peripheral arteries disease which arises due to damaged or poor blood circulation in arteries. Due to the lack of oxygen, the affected tissues begin to lose its life and die. The pain which arises after limb amputation is called phantom limb pain. This is quite common in legs and arms. Often the pain arises in removed parts such as the breast. If the pain is long lasting and severe, then it is the time to get diagnosed and undergo the necessary treatment. When the root cause remains unknown, studies say that it might be due to the rewiring of nerve in the brain and spinal cord when they fail to find signals due to missing limb. As a response, they send pain signals which cause the pain. It may be also due to a sensation of arm or leg missing when you are touched at hip or forehead. The pain is severe and feels like an electric shock, twisting, crushing or burning. To diagnose phantom pain there are no specific tests, the pain is identified and differentiated from others by collecting knowledge about your symptoms and the medical history before the starting of the pain. A clear and precise information about your difficulties and symptoms can help the doctor to diagnose for phantom limb pain better. Stump pain and phantom pain seems to share common symptoms, so it is important to diagnose it and treat for the right one.

It is difficult to find the right treatment for phantom pain. Initially, doctors will recommend medications and slowly they will add on noninvasive therapies. The most common therapies are acupuncture or transcutaneous electrical nerve stimulation (TENS). Other options include injections or implanted devices. Surgery is set aside as a last option when nothing of the above options works.

1. Medications: There are no specific medications for this kind of nerve pain, the drugs which are used to treat some other conditions were found useful in treating nerve pain. There is no common drug for this cure. Different medications need to be tried and we have to find the right one which can work for us. The medications which are commonly suggested by doctors are
• Antidepressants: damaged nerves can be treated using Tricyclic Antidepressants. The medications include tramadol (Conzip Ultram) and Pamelor (amitriptyline, nortriptyline ). They relay pain signals which work by modifying chemical messengers. They give better sleep and relaxation. Antidepressants impose sleepiness, dryness in the mouth, weight gain, blurred vision and decreased desire towards sex.
• Anticonvulsants: Drugs such as gabapentin (Gralise, Neurontin), carbamazepine(Carbatrol, Epitol, Tegretol) and pregabalin (Lyrica) are used as a medication for nerve pain. These epilepsy drugs control the pain signals and cure damaged nerves. Anxiety, depression, irritations and allergic reaction such as fever, swelling, and hives are the common side effects.
• Narcotics: common opioid medications such as codeine and morphine can sometimes serve as an option for some people. Pain can be controlled by taking appropriate doses.
• NMDA(N-methyl-d aspartate) receptor antagonists: these binds NMDA receptors towards nerve cells in the brain thereby blocking glutamate activity in the brain. Glutamate is a protein that plays an important role in relaying nerve signals. Common pain relievers are ketamine and dextromethorphan.
2. Non-invasive therapies :

It is a way of trial, observations and finding which therapy would be better for pain relief and cure. The techniques are:

• Nerve stimulation: normally weak electrical through a device through patches made of adhesive near the painting area through the skin. This is known as Transcutaneous electrical nerve stimulation (TENS). They interrupt pain signals from reaching your brain. TENS is found to be safe when used properly. Avoid turning it too high or while you are in the shower.
• Mirror box: A device consisting of mirrors which give a feeling that amputated limb exists. The box consist of two openings, stump opening and intact limb opening. When the person starts exercising, imagine that one is the missing limb is moving when the intact limb is being moved. This helps in relieving phantom pain.
• Acupuncture: NIH recommends this as one of the effective treatment for chronic pain. Stainless sterilized needles are inserted into acupuncture points in the body. This activates the central nervous system thereby releasing pain-relieving endorphins.
• Other minimally invasive procedures include injection such as steroids, anesthetics which can relive the pain. Tiny electrodes are inserted by the side of the spinal cord to deliver an electric current which can relieve pain. This is known as spinal cord stimulation. Nerve blocks are one kind of medications which can block pain messages between pain site and brain.
3. Surgery

This can be the last option when nothing other works. The two surgical options available are

• Brain stimulation: a method similar to spinal cord stimulation, but the current is delivered to the brain. MRI is used to find the position for electrode insertion and current delivery. This seems to be an effective option among selected individuals.
• Neurectomy or stump revision: this is also known as stump revision. this is used when nerve irritation in the stump is the reason for phantom pain. Sometimes nerve cutting can make the pain worse.

One who is having symptoms of phantom pain which is persisting for a long time, then he is eligible for treatment. If the symptoms are severe, one can approach a surgeon for an effective treatment.

Stump pain and phantom pain shares common symptoms. Therefore if the symptoms are not associated with phantom pain, then he/she won’t be eligible for treatment.

The medications being antibiotics and steroids, sedation, weakness, weight gain, fever, allergies, and vomiting are the common side effects. The therapies seem to be less risky if performed properly.

Proper exercise and medications are necessary after treatment. Since the chance is higher for the reappearance of phantom limb pain, the medications need to be followed whenever severe pain occurs again.

Phantom limb pain never goes away. The pain gets weaker and you will feel the pain less often after the treatment. It doesn’t have a permanent cure.The recovery time for the treatment varies from one patient to another patient health condition. For some patients the medication may show positive results as soon as possible and some may report issues due to allergic or any other health related issues.

Cost of medications starts around Rs 100 and extends depending on the cost of medications. Acupuncture and therapy sessions are charged Rs 500-Rs 1000 per sessions. You may need multiple session for a better cure. The surgery ranges Rs 15000 and extends up to Lakh depending upon the hospital you choose.

The results may not be permanent. You can feel relief from pain and the intensity of reoccurrence of phantom limb pain gets reduced with the treatment.

Engage yourself in physical activities such as cycling, swimming and other activities you enjoy doing. This can helps you to be physically active. Lie down and perform relaxation techniques that can reduce your muscular tension. Breathing, meditation, and visualization techniques are really helpful. Find activities that take away your concentration from pain. Often reading and listening to music is a good option. Massaging, apply warmth in the pain area can reduce the intensity of the pain.