Phantom Limb Research Paper

Several years ago, my stepbrother, Travis, lost the tips of two fingers on his right hand in a work accident. The first time he tried to shoot a gun after the accident, he did not realize his fingers did not even reach the trigger. That is just one example of phantom limb. Most people with phantom limb have what is called phantom limb pain. Phantom limb pain refers to ongoing painful sensations that seem to be coming from a part of the limb that is no longer there (“Managing Phantom Pain,” 2016). Even though the limb is gone, the pain is real. Phantom limb pain has different causes, different symptoms and different treatments. The exact cause of phantom limb pain is unclear. Doctors once believed this post-amputation phenomenon
was a psychological problem, but experts now recognize that these real sensations originate in the spinal cord and brain (Staff, B. M., n.d.). It is thought to be caused or at least partially explained by mixed signals from your brain or spinal cord. Areas of the spinal cord and brain lose input from the missing limb and adjust to this loss in unpredictable ways. The sensation tells the central nervous system that something is wrong. Although the limb is no longer there, the nerve endings at the site of the amputation continue to send pain signals to the brain that make the brain think the limb is still there. Since the memory of pain is still there it is interpreted as pain, regardless of signals from injured nerves. In addition to the memory of pain, there are other factors that may contribute to phantom pain, including damaged nerve endings and scar tissue at the site of the amputation.
Imaging scans like an MRI or a PET, show parts of the brain that were neurologically connected to the nerves of the amputated limb having activity when the person feels phantom pain (Staff, B. M., n.d.). There have also been studies that show the brain may remap the amputated limb's sensory circuitry to another part of the body (Staff, B. M., n.d.). So, because the amputated area is no longer able to receive sensory information, the information is referred elsewhere. For example, from a missing hand to a still-present cheek, when the cheek is touched, it is like the missing hand also is being touched. The result is pain because of tangled sensory
wires. It is believed that nearly 80 percent of the amputee population worldwide has experienced this kind of pain (“Managing Phantom Pain,” 2016).
It is often felt in fingers or toes. It can feel like a variety of things, such as burning, twisting, itching or pressure. Some people experience other sensations such as tingling, cramping, heat, and cold in the portion of the limb that was removed. Also, any sensation that the limb could have experienced prior to the amputation may be experienced in the amputated phantom limb. There are several other characteristics of phantom limb pain. It usually starts within the first few days of an amputation. This pain can come and go or be continuous. It often affects the part of the limb farthest from the body, such as the foot of an amputated leg. Some say it feels as if the phantom part is forced into an uncomfortable position. It is also thought that the pain may be triggered by emotional stress or pressure on the remaining part of the limb. Successful treatment of phantom limb pain is difficult. It is different from the treatment you would receive for other kinds of pain and is usually based on the person's level of pain. Treating phantom limb pain effectively takes a multipronged approach, meaning both medication and non-medication treatments are used. The medication therapies are used to change or interrupt the signals from the brain or spinal
cord. There are many different categories of medications that can decrease phantom limb pain. Each of them is thought to work on different kinds of pain sensations. The categories of some of these medications include (“Managing Phantom Pain,” 2016):
• Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs)
• Opioids (narcotic pain medications)
• Antidepressants
• Anticonvulsants
• Beta-blockers
• Muscle relaxants There are many non-medication therapies that are used to help interrupt the brain’s interpretation of the signals from the brain or spinal cord. These complementary therapies include (“Managing Phantom Pain,” 2016 and “Phantom Limb Pain,” 2015):
• Acupuncture
• Massage of the residual limb
• Use of a shrinker
• Repositioning of the residual limb by propping on a pillow or cushion
• Mirror box therapy
• Biofeedback to reduce muscle tension
• TENS (transcutaneous electrical nerve stimulation) of the stump
• Virtual reality therapy
• Imagery
• Music
• Heat application
• Relaxation techniques
• Surgery to remove scar tissue entangling a nerve
• Physical therapy
• Neuro-stimulation techniques such as spinal cord stimulation or deep brain stimulation For some people, phantom limb pain gets better over time without treatment. For others, managing this pain can be challenging. The length of time this pain lasts differs from person to person. It can last from seconds to minutes, to hours, to days. For most people, phantom limb pain diminishes in both frequency and duration during the first six months, but many continue to experience some level of these sensations for years. When phantom limb pain continues for more than six months, the chances of improvement are not good. It is still unknown why some people have phantom limb pain after an amputation and others do not. But it is more likely for those who had pain in the limb before amputation to have phantom limb pain. Even though the pain is real, many people do not want to tell anyone that they are experiencing phantom limb pain because they fear that they will be considered “crazy.” However, it is important to report these pains as soon as possible so treatment can be started.