5 Ways to Deal With Phantom Limb Pain After Amputation

Pain and strange sensations are common
man with amputated leg exercising

Most people experience some pain after undergoing surgery. It’s part of the healing process and generally subsides as your tissues repair themselves. However, it’s not that simple if you are recovering from an amputation.

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After the initial post-surgical pain subsides, you may experience several types of sensations — some painful and unpleasant, others strange and disconcerting.

Doctors can help amputation patients control these sensations early on to limit long-term problems with post-amputation pain.

Amputation is sometimes necessary in cases of trauma — such as injuries from car accidents or military combat. Some medical conditions also progress to a point where amputation is necessary. People with vascular diseasediabetes, and even certain tumors may eventually need an amputation.

Types of post-amputation sensations

“After the initial surgical incision and deeper tissues have healed, many amputees report sensations associated with the removed limb,” says pain management specialist Robert Bolash, MD. “It’s important to differentiate between the types of sensations in order to understand and treat them.”

Phantom sensation

Sometimes a patient feels that a removed body part is still in place.

“It can be an arm or a leg, but can even happen with breast cancer patients who have had a mastectomy,” says Dr. Bolash. “These women sometimes have a sensation that the breast is still there.”

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A person experiencing “telescoping” has the feeling their missing limb is still there, but that it has shrunk to a very small size, similar to a collapsed telescope. There’s no mention of pain with this common type of sensation, but it is unnerving.

Most patients experience phantom sensations of some sort within six months of an amputation.

Phantom pain

Patients experiencing this sensation report an actual feeling of pain, ranging from mild to severe, in the missing body part.

“Although amputations have occurred throughout human history, phantom pain first became clearly defined by a Civil War physician,” says Dr. Bolash. “This physician noted that as many as 90 percent of soldiers with limbs amputated during wartime developed some degree of phantom pain.”

Thanks to advancing surgical techniques, phantom pain affects fewer people today, but about 60 to 70 percent of patients still feel some phantom pain, Dr. Bolash says.

It’s difficult to pin down the precise frequency because patients often are reluctant to report it. It’s very real to them, but they can clearly look and see that the limb is gone, so they worry that their physician might begin to doubt their sanity, he says.

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Residual limb pain

This type of pain occurs in the part of the limb that’s left behind — often referred to as the stump — after the amputation.

“At the amputation site, some people develop a neuroma” says Dr. Bolash. “This occurs when a cut nerve ending forms a tiny ball on its end during healing or gets trapped in the suture line when the surgeon closes the incision.”

This is not phantom pain, but pain originating from the stump. Poorly fitting prosthetics or limb bruising can cause residual limb pain as well.

5 techniques for managing post-amputation pain

The success of treatment for post-amputation pain depends on your level of pain and the various mechanisms playing a role in causing the pain. Dr. Bolash shares five of the most effective treatment techniques:

  1. Mirror box therapy: “This is a very specific type of physical therapywith proven efficacy for patients with post-amputation pain,” he says. The patient actually watches in a mirror while receiving PT to re-map the brain’s neural pathways to register that the limb is no longer there.
  2. Local injection therapy:The physician injects a local pain-blocking agent at the amputation site. This can calm the painful signals sent by the nerve endings to the brain.
  3. Non-opiate analgesic: These prescription pain medications slow or limit how the painful nerves send signals to the brain.
  4. Deep brain stimulation: In this technique, a surgeon places tiny electrodes directly on the surface of the brain to help attenuate pain with electrical impulses.
  5. Nerve cuff stimulation:This technique involves placing a nerve stimulator on the nerves traveling to the amputated leg. The nerve stimulator resembles the wrapper on a straw but is only about a centimeter long. It has a small electrode inside of it and encases the nerve itself. Rather than blocking the nerve signals, it sends a pleasant signal through the nerve. “We’re currently conducting a studyusing this technique and are actively recruiting participants,” Dr. Bolash says.  He says patients tolerate the procedure quite well. They can activate the cuff on the nerve ending via a small wireless remote control. When they begin to feel pain, they press a button and the device delivers an imperceptible electrical stimulation to replace the pain sensation as it travels to the brain.

Don’t hesitate to get help

Dr. Bolash encourages anyone with post-amputation sensations to discuss it with their physician immediately. No one will think the person is losing their sanity, he says. Early treatment by an experienced pain management expert can reduce the chances that the problem will develop into something more severe in the future.

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