What is Phantom Pain?

Phantom limb pain – Pain appearing to come from where an amputated limb used to be – is often excruciating and almost impossible to treat. New approaches, based on a better understanding of the brain's role in pain, may be opening the way to new treatments.

What is Phantom Pain?
Following amputation of a limb, the amputee typically continues to have an awareness of the limb and to experience sensations that feel like they are coming from that limb. These are commonly referred to as phantom limb sensations and are also found to be present in children born without a given limb. This suggests that the perception of our limbs is 'hard-wired' into our brains and that feelings from our limbs become mapped into our brain networks as we develop.
If we consider that phantom limb sensations are normal then so too, is phantom limb pain. This pain feels quite real and occurs in a majority of those who have lost a limb. Phantom pain has also occurred in conditions in which the brain is disconnected from the body, such as peripheral nerve injuries and after spinal cord injury, when an area becomes insentient (and usually paralyzed). This may sound confusing but, no more than an amputee describes the pain he or she feels from the area where a limb that is no longer attached to the body used to exist.

The pain is described in various ways: burning, aching, itching, like lightening and cramping as though the hand, fingers, foot, or toes are cramping or being crushed in a vice. Such words, however, cannot fully encompass the experience of living with phantom pain. Traditional medicines will likely fail as the muscular skeletal structure is no longer there and cannot be affected by medications. In those with chronic pain after spinal cord injury it is frequently the pain rather than the paralysis that interferes with work and social life. One amputee has stated that paralysis does not stop life, but pain can certainly slow it down.

Nerve Endings
There could be several mechanisms underlying phantom limb pain, some physical, others could be mental. Damage to nerve endings would certainly be a physical cause: subsequent erroneous nerve re-growth could lead to abnormal and painful discharge of neurons in the stump. This random nerve ending re-growth could alter the way that nerves that once connected the amputated limb communicate with neurons within the spinal cord.
There is also evidence for altered nervous activity within the brain as a result of the loss of sensory input from the amputated limb. This might further be described as a pulse sent by the brain to the missing limb and not getting a ( required ) response and the pulse being sent repeatedly. Still not receiving a response, the brain might assume something is wrong and trigger a ‘pain alarm’; something to draw attention to the affected area. This would then be more of an emotional rather than physical sensation. Granted, this may sound unreasonable but, the mind is a very powerful thing and you need to be in control of it rather than the reverse.

As an amputee myself, I can easily relate to the sensation of phantom pains in my missing limb. The sensations are just that, sensations and not what I consider pain. Pain has the connotation of hurting; having a part of the body which is no longer there that hurts is simply not acceptable in my mind. The idea being that if I can’t see or touch the body part, then how am I to resolve it if not with my mind. I generally describe the sensations as sometimes having the tingling sensation of being ‘asleep’ other times it might be like fireworks or lightening strikes going through what used to be my foot. It requires effort and repetition but, the simple fact is that since my foot is not there, the ‘pain’ cannot exist. It may sound like a leap of faith but the other side of the coin is that if I let it ‘hurt’ then it could only get worse and that, is not acceptable.
Click here for more prosthetics information