Phantom pains

[Christina HPMD]

For those who know me, please forgive the repetition...this is for those 
new subscribers who don't.... I hope it will help clarify some recent posts 
on the subject of phantom pains, when all else has failed...

Hello, My name is Christina, I've been a hemipelvectomy amputee (entire 
leg, hip and half my pelvis) since 1962 due to cancer.  I've also been a 
doctor since 1972, specialty is Anesthesiology.  I am not an expert in the 
phantoms, but I know them personally, still suffer occasional bouts.  I've 
done extensive reading and am familiar with most of the current treatments.

Some basic facts:
There is NOT ONE treatment which is 100% effective for all people.
There are many different treatments which may be 100% for specific 
individuals, each person's pain must be evaluated and treated on an 
individual basis, there are no guarantees.

TENS units have been helpful in some chronic pain problems including the 
phantoms, but there is very little in the medical literature specifically 
relating to the phantoms.  It  is an EXTERNAL treatment.  Pads are placed 
on the skin and an electrical stimulation is given.  This stimulation 
travels through the nerves and in some cases can over-ride the pain 
impulses of the phantoms.  Results are variable, but it is very safe and 
completely reversible.

SPINAL CORD STIMULATORS consist of a wire or lead which is placed in the 
epidural space near the nerve roots.   The exact placement depends on where 
the pain is. Usually a trial placement of leads is done first under local 
anesthesia with sedation.  The lead is attached to an external device which 
provides electrical stimulation which causes a "buzzing" or "tingling" 
sensation.  The goal is first to cover the area of pain with this tingling 
and various amounts of stimulation are provided which hopefully will 
over-ride the pain impulses with non painful stimulus.  If the person gets 
relief, a week or 2 later, the leads and the generator are buried under the 
skin.  This is usually done under a general anesthetic.  The amount of 
stimulation is variable and can be adjusted by an external adjustment 
gizmo.  The results have been variable, it depends on each individual.  The 
generator needs to be changed about every 2-3 yrs  to replace the 
batteries.  As with ANY treatment for chronic pain, the effects appear to 
decrease over time, in other words, it may work great at first, but may 
become less effective over a few years time.

MORPHINE PUMPS consist of a very small tube which is also placed in the 
epidural space, again exact placement depends on the area of pain.  A 
certain concentration and amount of morphine is placed in the pump and the 
amount of medication delivered is adjustable.  A trial is done first, and 
if successful, the person returns a few weeks later to have the tube and 
pump surgically placed under the skin.  Additional supplies of morphine are 
added as needed by being injected through the skin directly into the pump 
reservoir by way of a large syringe and special needle.  Again, the results 
have been variable, and very little is in the medical literature about this 
treatment specifically for use in treating phantom pains.

Both the spinal cord stimulator and morphine pump are INTERNAL devices, 
which require surgery and anesthesia.  Therefore all of the inherent risks 
involved with ANY surgery or anesthetic are present.  Be aware that there 
are no 100% guarantees.  Even in the best trained and skilled hands, 
complications can and do occur.  Most common and most disturbing is 
infection.  Both the leads or tubes are placed close to the spinal 
cord,  infection may result in meningitis and even death.  I've seen this 
personally.... twice!  Therefore, I would advise anyone who is considering 
these treatments to fully investigate and try all other non-invasive 
treatments first.  Also, be sure that your pain doc has the credentials, 
professional training and experience in these devices.

To check your pain docs credentials, contact your local county or state 
medical board.  Other sources for information are:

  American Society of Anesthesiologists (ASA) has a web site covering the 
subject of management of pain: www.asahq.org/Patient_Education/pain_manage.html

  American Pain Society:  www.ampainsoc.org  (This organization can provide 
referrals for patients, listed  by state, and is a good source for 
information.)

  World Wide Congress of Pain, sponsored by the Dannemiller Foundation
www.pain.com  - has a listing of pain specialists according to 
state.   Other parts of this site involve consumer information and permit 
users to "Ask the pain doc"  questions.

Hope this answers some questions and clarifies the differences.  Good luck.

Christina HPMD