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[Thom Bloomquist, MS, CRNA]

I would like to know if there is anything out there that works for phantom
pains with not many side effects. I am having them regularly as I have been
for years. But being a single mom I can not be sleepy all the time.
Susanna
I can understand that.  I wish I had a magic wand to take away everyone's
pain.  But our magic wands are working this week.
The problem is phantom pain as compared to other pain states is one is
dealing with a nervous system, literally changed by the experience.  The
nerves that try to resprout form neuromas.  Normally silent high-threshold
pain nerves have been activated.  The remaining part of the limb is asked to
support pressures and stresses -they were never designed for.  Non-affected
body parts must work harder and sustain extra stresses, which can lead to
arthritis and chronic musclo-skeletal pain.   Frequently there is chronic
depression (understandably), anger and such factors can lead to a feelings
of social isolation.  On and on we could go.
However, by listing these changes and problems - I don't imply for a second
that the situation is lost or helpless - far from it!  Amputees are some
world's most inspirational survivors.  One lady said it this way; "When you
fall down or get knocked down - you get up - put on another coat of rogue -
and keep walking"
It is hard to make recommendations for someone you have not met, without the
charts, labs, tests, meds, allergies - in short all that we use to generate
a plan.  Thus we can talk only in generalities.
First - expectations.  Relieving all pain is probably an unrealistic goal -
yes?  Making it like "was" also not possible.  (You would be surprised how
many people actually ask for such things.
Secondly - a goal.  Focus not on a pain score of this or that - rather
establish functional goals - what do you want to do when pain impacts your
life less?
Third - you must be prepared to make more changes - simple and obvious
though it sounds - this is hardest for some people.
Phantom pain is mix of peripheral and central factors.  Central factors are
changes in the pain signaling system.  These central changes are aggravated
by more pain alarms.  For example - a poor fitting prosthesis can be a
constant source of alarms.  So first do all that you can do to limit those
things you can control.  Get the best prosthesis fit you can get.  If you
need an assistive device  to take stress off that other leg, now asked to
work harder - do it.  Be mindful of your posture.  Keep you weight down, do
stretch/exercise - everybody can do something.  Stretched muscles are more
resistant to spasm.  (I know this may be all review for you - but I can't
know what you know) .
We use two camps of tools.  The first camp is low potency but safe. This
includes massage, biofeedback, acupuncture/pressure, assistive devices,
micro-currant technology and nutritional supplements.  (I advise most of my
chronic pain patients to take extra magnesium).  The second camp of tools
are more potent but also have more side effects and complications.  This
includes potent meds, specialized injections, implantable devices like nerve
stimulators and brain transplants (just kidding).
We try to get as much mileage out of the first group as possible before
adding in the second group.  For most people, phantoms are a form
Neuropathic pain.  This form of pain generally does not respond well to
drugs like morphine or NSAIDs like ibuprofen.  (But pain from other parts
might).  Neuropathic pain tends to respond better to anticonvulsants. I
don't know what country you are in -  specific names may be different.
Some things that don't work - valium like drugs do not work well on this or
most forms of pain. (But might be helpful is patient also has an
anxiety/panic problem)   We don't recommend mixed agents like nalbuphine or
butorphenol.  (Stadol or Nubain). We do use a multi-modal approach with
different types of drugs and measures.
We have an electrical device that works at the mirco-currant level (.5MA x.5
hz).  Several devices by different companies and names.  We have the Alpha
Stim.  It takes my phantoms away immediately and completely.  (However - to
use it I must be off my leg).  It's a camp 1 item (Low potency and safe) No
chance or sides effects or allergy, no needles -it's external skin contact.
In the US, it's by prescription only but in Europe its over the counter.
(such differences drive me nuts)
Then there are camp II drugs like gabapentin, mexilitine, calcitonin and
beta-blockers.  All these work for someone people but nothing seems to work
for everyone.   Adjunctive medicines like amytryptyline, drugs in that class
can help and make real differences for people.
Adequate sleep is crucial!  Not just the number of hours but waking feeling
rested. Biofeedback and hypnosis can be very effective at reducing pain
generated by muscle spasms. Some people get locked into thinking about a
"pill" to take away their pain.  Biofeedback and hypnosis are real -
effective therapy for people who learn how to use them.  (some of those
changes I mentioned)
Remember we are speaking in generalities here  -this isn't medical advise -
don't do this at home - I was never here....:)
I must toddle off to work - more later...

Thom