Phantom pain is pain that seems to come from a part of the body that is no longer there. Doctors used to believe that this post-amputation phenomenon was a psychological problem, but experts now recognize that these real sensations come from the spinal cord and brain.
Most people who have had a limb removed report that they sometimes feel that the amputated limb is still there. This painless phenomenon known as phantom limb sensation is not the same as phantom pain.
In some people, phantom pain improves over time without treatment. Phantom pain can be difficult for others to deal with. You and your doctor can work together to effectively manage phantom pain with drugs or other therapies.
Features of phantom pain include:
Start within the first week after the amputation, but may be delayed by several months or more
Pain that comes and goes or persists
Symptoms that affect the part of the extremity furthest from the body, such as: B. the foot of an amputated leg
Pain that can be described as gunshots, stabbing, cramps, pins and needles, bruising, throbbing, or burning
The exact cause of phantom pain is unclear, but it appears to be in the spinal cord and brain. During imaging studies – such as magnetic resonance imaging (MRI) or positron emission tomography (PET) – parts of the brain that were neurologically connected to nerves in the amputated limb show activity when the person experiences phantom pain.
Many experts believe that phantom pain can be explained, at least in part, as a response to mixed signals from the brain. After amputation, areas of the spinal cord and brain lose data from the missing limb and adapt to this detachment in unpredictable ways. The result can trigger the body’s most basic message that something is wrong: pain.
Studies also show that after an amputation, the brain can relate that part of the body’s sensory circuitry to another part of the body. In other words, since the amputated area can no longer receive sensory information, the information is sent back to another location – for example, from a missing hand to an existing cheek.
Not all amputees develop phantom pain. Some factors that can increase your risk of phantom pain include:
Pain before amputation. Some researchers have found that people who had limb pain before the amputation would likely suffer afterwards. This may be because the brain retains memories of pain and continues to send pain signals even after the limb is removed.
Residual pain in the limbs. People with persistent pain in the remaining part of the limb also usually have phantom pain. Remaining limb pain can be caused by abnormal growth of damaged nerve endings (neuromas), often resulting in painful nerve activity.
Because the risk of developing phantom pain is higher in people who had limb pain prior to amputation, some doctors recommend regional anesthesia (spinal or epidural) in the hours or days prior to the amputation. This can relieve pain immediately after surgery and reduce the risk of persistent pain in the phantom limbs.