What is phantom pain?Infogram to the pain regions, course and development of pain as well as the intensity levels in pain perception. Click on the image to enlarge.
Already in the ancient civilizations of humanity, for example in ancient Egypt or in the South American Mayas, doctors have already amputated ill or injured limbs. In former times, gangrene was a common cause of the amputation of an arm or leg and often the only hope to save a human life.
Even today, limbs sometimes have to be amputated, for example due to irreparable injury from an accident or an infectious disease.
An estimated 50 to 80 percent of patients who have had their limbs or organs removed subsequently complain of phantom pain or phantom sensations in the now missing parts of the body.
Phantom pain usually occurs within a month after surgery and can be experienced with varying degrees of intensity. In rare cases, sufferers but only for months or years complain for the first time about phantom pain.
Science has not yet been able to find concrete causes for the phenomenon of phantom pain. A few years ago it was believed that the reason for the virtual pain was inflamed nerve stumps. Today doctors assume that the phantom pain is due to a kind of confusion of the brain.
Even after amputation, the brain has not classified the limb or organ as missing and continues to proceed from the old, complete body schema. This approach also explains why phantom sensations occur: Some patients, for example, think they can gesticulate with a missing hand.
Another observation supports the thesis of the brain, which can not rethink: Phantom pain in its intensity depends on the real perceived pain before surgery. The patient's brain seems to remember the real pain experienced before surgery.
Some people claim phantom pain in a weather change to former wounds or fractures, for example, from high pressure to a gravure, to feel. However, this cause has not yet been scientifically verified and therefore represents a subjective sensation.
Symptoms, complaints & signs
Patients can usually tell exactly where they feel the phantom pain. For example, a person whose right forearm has been amputated may feel the phantom pain in the (now missing) palm of the hand or in the little finger and ring finger. Although the pain does not come from an adequate stimulus in the amputated tissue, the nervous system reacts as if there were a corresponding neuronal stimulus. The pain is not simulated and does not occur directly on the stump.
Basically, the phantom pain can develop in any part of the body that has been amputated. However, the symptoms are particularly common when the surgical site is close to the trunk. Phantom pain is often phased. Continuous pain is also possible, but is less common. Both the pain attacks and the permanent phantom pain are a burden that often causes mental discomfort.
Both the intensity and the quality of the pain can vary. The phantom pain can feel stinging, cutting or burning. Affected may also have the impression that they have a painful spasm in the amputee body part.
Some patients suffer from phantom pain immediately after amputation. In other cases, the symptoms only appear after a long time. Most sufferers develop the phantom pain within the first month after surgery. However, the symptoms can appear even after several years for the first time.
Diagnosis & History
The phantom pain is mainly diagnosed based on patient descriptions. However, before the doctor is committed to this diagnosis, he must first rule out organic causes of the pain. So-called stump pains are also common after amputation and are sometimes difficult for the patient to distinguish from phantom pain.
Dull pains are often triggered by pressure points caused by ill-fitting prostheses, inflammations or circulatory disorders. Phantom pain usually occurs in the form of attacks or attacks. Rarely are they described as constantly present.
The type of pain can be very different: patients reported sharp, burning, cramping, stinging or cutting phantom pain. Also in intensity and duration are different phantom pain. Some people suffer so much from wanting to kill themselves.
Phantom pain after amputation is common, affecting about 70 percent of all sufferers. To a certain extent, it is normal and is often associated with blunt discomfort. Even if phantom pain is harmless in most cases, a doctor should be consulted so that the symptoms do not worsen or become chronic.
It is important that phantom pain is treated early, otherwise the body will develop a so-called pain memory. In this case, the brain sends signals to the amputated body area and there is no response. If this happens several times, the brain classifies the missing feedback as an injury and responds with pain. Therefore, it is important to counteract this pain memory as early as possible.
Phantom pain can be very severe and require painkillers. A long-term use of painkillers, however, again entails the risk of becoming dependent on painkillers. In addition, phantom pain can increase irritability and sleep disorders, and limit both health and social life. Without treatment, you may also experience depression or even mental illness that requires treatment.
When should you go to the doctor?
The phantom pain is suffered by people who have lost body parts. Other people are not part of the risk group of this unpleasant pain experience. If the sufferer perceives discomfort in areas of the limbs that have been severed by an accident or amputation, he should consult a doctor. What is needed in these cases is a therapeutic work with various exercises and trainings, so that a necessary reprogramming in the brain can take place. Otherwise the symptoms will continue or increase in intensity. For a treatment plan can be created, a doctor's visit should be made.
For sleep disturbances, a continuing stress life, internal restlessness as well as an impairment of the joy of life a physician is to be consulted. If it comes to autonomic dysfunction, changes in personality, a general dissatisfaction or a restriction of lifestyle, a doctor is needed. Depressed mood, indifference or behavioral problems should also be discussed with a physician. Disorders of concentration, attention deficits and diminishing exercise capacity are signs of health impairment.
A doctor should be consulted for alleviation of the condition. Often the intensity of the symptoms varies. There may also be a period of non-objection. In these times, normally no doctor is needed. However, if the pain recurs after a certain period, it is advisable to consult a doctor.
Treatment & Therapy
There is no single treatment option for phantom pain. Possible therapies must be individually tailored to each patient and help the brain to reorganize. Usually the phantom pain is treated with medication, a physical or psychosomatic therapy or a combination of some or more of the mentioned possibilities.
Severe cases of phantom pain are first treated with numbing opiates, such as morphine, to relieve the patient's distress. Common is treatment with antidepressants and / or electrostimulation. An electrode placed under the skin irritates the spinal cord with electrical impulses that are intended to distract the brain from phantom pains.
Newer methods such as mirror therapy and virtual reality therapy seem to be very successful. Both therapies simulate the amputated limb and urge the patient to move it and release it from its painful position. A targeted distraction and other employment of the patient can sometimes make the phantom pain disappear.
On the other hand, therapies such as acupuncture, hypnosis, physiotherapy or biofeedback have proven to be of little help. Treatment methods such as a shortening of the stump, a separation of the sensory nerves in the spinal cord and the removal of the thalamus are no longer common. They usually showed little or no success.
Outlook & Forecast
How the prognosis for phantom pain turns out depends on certain factors. It is especially important to start with the medical treatment of the pain as early as possible. If the pain treatment is positive, occurs in about 70 to 90 percent of all affected persons a favorable course of the symptoms. However, if the pain therapy is started at a later date, the prospects are less favorable. Thus, only a third of the patients show a positive course of healing.
How long the phantom pain holds, can not be said in principle. So there is the possibility that the pain will disappear spontaneously. Likewise, however, a sudden return of painful complaints is possible. The prognosis is particularly unfavorable if the patient suffers from amputation pain for more than half a year.
An important role in the further course of the symptoms is the type of amputation pain. Sudden abrupt abdominal pain begins immediately after surgery, and in some cases can become chronic. Often, however, they are acute and precipitate violently. In the case of phantom pain, a prolonged persistence of the symptoms is generally to be expected. In addition, the pain can show up again at any time.
Sometimes the phantom pain arises as a result of inflammation or infection. The administration of antibiotics usually improves the prognosis.
Phantom pain is difficult to prevent. In many cases, however, the administration of neuroleptics or analgesics before a planned operation has proved helpful. Phantom pain subsequently did not occur as strongly or in some cases not at all.
A phantom pain may resolve with appropriate therapy in the first few weeks after amputation. Many patients do not need follow-up because they have no complaints. Subsequent acute feeling of discomfort is not uncommon, but can usually turn off without consultation of a doctor. However, if there are recurrent pain attacks or a constant feeling of pain, aftercare becomes indispensable.
The extent of follow-up depends on the intensity of the complaints. A long-term treatment with drugs is not uncommon. Promising are sometimes alternative treatments. Depending on the severity of the symptoms, psychotherapy may be appropriate. The mediation of relaxation exercises often helps just as much.
Some sufferers suffer so much from their condition that they attempt suicide. The controls and treatments are designed to identify and address early-stage malady tendencies. As part of the aftercare, especially the patient's sensations are reflected.
Physical examinations serve to exclude other diseases. The attending physician documents the effect of treatments performed. What promises success, is continued, which contributes to any improvement, is discarded. A phantom pain doctors can not prevent because of the unpredictable emergence. The aftercare can thus, as usual with tumor diseases, no preventive character.
You can do that yourself
People suffering from phantom pain can improve their symptoms through cognitive approaches. Because the pain in the brain is stored on the basis of experiences as well as experiences and is not based on a real impact, training can bring about a relief of the pain. Helpful is the use and support of a therapist. Together with him exercises can be developed, which the affected person can carry out himself in everyday life on his own responsibility as needed.
Helpful and very promising are the approaches of mirror therapy. They represent an enormous relief for the patient and improve the well-being considerably. In consultation with the therapist, the training sessions carried out can be carried out independently between or after the treatments. With skill exercises in front of a mirror sensations are evoked, which help with the pain management.
In addition, awareness processes in dealing with the changed situation are helpful. Because it is an imagined pain, some patients manage to alter their stored memories in a targeted way. Cognitive techniques offer possibilities and methods that can also be used by the patient independently in everyday life. The phantom pain should not be ignored, as this can lead to an increase in symptoms and significant impairment in everyday life.