Current Treatment of Phantom Limb Pain

Phantom Limb Pain

Current Treatment of Phantom Limb Pain

Dr. Louis Bojrab, MD, FIPP

Michigan Pain Specialists

Phantom limb pain is a pain that is experienced in a limb that has been amputated. The amputation could be surgical or traumatic, and this painful disease can result in a chronic pain disease state in some cases. There is a difference between the experience of the missing limb still being there which is called phantom limb sensation, which occurs in approximately 60-80% of amputees. 1 If this experience of this limb is painful it is called phantom limb pain, which occurs in. This discussion is devoted to the painful sensation only. The prevalence of phantom pain was 72% for the total group, 41% in upper limb and 80% in lower limb.3

More rarely, when other appendages have also been diagnosed with pain such a breast, ear, that creates a lifetime of chronic pain also. There are other types of sensations of a phantom limb other than pain, such as various as the sensations in a non-amputated limb, such as squeezing cramping. By far the most medical appointments focus on treating the pain. There have been various treatments such as medications, biofeedback, physical therapy, nerve blocks, applying creams and devises to the stump, acupuncture, transcutaneous nerve stimulation, and Spinal Cord Stimulation, and most recently botox injections in the painful area of the stump location. Once patients with phantom limb pain come to Michigan Pain Specialists, the vast majority have tried many of these treatments, but are still in chronic pain. After a careful evaluation, your pain doctor will discuss with you the treatments that you need to consider for your medical situation. We will focus on three of the most utilized successful treatments below:

 

Sympathetic Blockades.

For the arm it is a Stellate Ganglion Block, and for the leg it is a Lumbar Sympathetic Block. These blocks do 2 important things. First, immediately after the procedure, pain can be assessed to see if the pain is present or gone. This tells your doctor which nerves are causing your pain. Second, this restarts the sympathetic nervous system in that limb and can cause improving pain each time this is performed. This is much like pulling the plug in your computer when nothing else works, and the computer restarts and corrects itself.

 

Spinal Cord Stimulation.

This procedure has a Trial and a Permanent procedure. The Trial is an injection of a temporary lead in the epidural space that creates complex computer calculations to give pain relief. This is much like a epidural does for childbirth but using electrical current, no medications are used. Medical literature documents a 74% success rate 5 for this procedure overall and is the mainstay of treatment for intense cases of phantom limb pain. 5, 6, 7, 8

 

Botox use for phantom limb pain.

The most recent medical study was done with the following results “In all cases phantom pain was reduced about 60-80%. The three patients, who had pain attacks, reported a dramatically reduction of the number of attacks (about 90%). In two of them duration of attacks shortened from 120 to 5-10 min and a reduction of pain intensity from VAS 9 to VAS 1 and VAS 9 to VAS 2 was reported.” Even though this is one study so far, this author has been impressed with the results for his own patients. 4

Our physicians are available for evaluation and treatment of phantom limb pain and many other painful diseases. We are a technologically driven practice of board-certified pain physicians who can and will help you, especially if you have been to other physicians and still have pain.

 

 

References:

  1. Chin J Traumatol. 2018 Dec; 21(6): 366–368. Published online 2018 Dec 4. doi: 10.1016/j.cjtee.2018.04.006
  2. https://my.clevelandclinic.org/health/diseases/12092-phantom-limb-pain
  3. Dijkstra et al. Phantom Pain and Risk Factors:A Multivariate Analysis. Journal of Pain and Symptom Management. Vol. 24 No. 6 December 2002
  4. Kern et al. [Treatment of phantom pain with botulinum-toxin A. A pilot study]. 003 Apr;17(2):117-24. doi: 10.1007/s00482-003-0202-5.
  5. Nagpal et al. The Effectiveness of Dorsal Root Ganglion Neurostimulation for the Treatment of Chronic Pelvic Pain and Chronic Neuropathic Pain of the Lower Extremity: A Comprehensive Review of the Published Data. 2021 Feb 4;22(1):49-59. doi: 10.1093/pm/pnaa369.
  6. Gilmore et al. Percutaneous 60-day peripheral nerve stimulation implant provides sustained relief of chronic pain following amputation: 12-month follow-up of a randomized, double-blind, placebo-controlled trial. 2019 Nov 17;rapm-2019-100937. doi: 10.1136/rapm-2019-100937.
  7. Lu YS, Tong P, Guo TC, Ding XH, Zhang S, Zhang XJ. Effects of combined rTMSand visual feedback on the rehabilitation of supernumerary phantom limbs in a patient with spinal cord injury: A case report. World J Clin Cases. 2019 Oct6;7(19):3120-3125. doi: 10.12998/wjcc.v7.i19.3120. PMID: 31624763; PMCID:PMC6795722.
  8. Lu YS, Tong P, Guo TC, Ding XH, Zhang S, Zhang XJ. Effects of combined rTMSand visual feedback on the rehabilitation of supernumerary phantom limbs in a patient with spinal cord injury: A case report. World J Clin Cases. 2019 Oct 6;7(19):3120-3125. doi: 10.12998/wjcc.v7.i19.3120. PMID: 31624763; PMCID: PMC6795722.
Author
Louis D. Bojrab, MD, FIPP Interventional Pain Specialist at Michigan Pain Specialists, PLLC

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