Phantom pain

[rodgerole]

Can anyone comment on how long it takes this to go away?  I've heard that for some people, it is an on going problem.  I hope that is the exception rather than the rule!  Jim Street
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Hi Jim,  My phantoms were intermingled with diabetic neuropathy,but I got considerable relief by taking neurontin. (1200mg/day)  They were mostly gone after 5-6 months,but I still get an occasional twinge.  Don't know for sure if it's the neuropathy or if the phantoms are still hanging on.  I suspect neuropathysince I have similar feelings in the foot I have left.  Here is a list of things suggested for relief if the pp's bug you to much.

Ole rak 01/02
SUGGESTED PHANTOM PAIN TREATMENTS 

Acupuncture 
Acupuncture is a healing art that has been practised in China for 
several thousand years to treat a variety of ailments, including chronic 
pain. Acupuncture involves the insertion of tiny needles into the skin at 
specific sites. The needle is then twirled for a few minutes or a low 
electrical current is applied. It is not fully understood how 
acupuncture works - the Chinese healing art stresses the energy flow of the Ch'i, 
or life force, while western medicine suggests it stimulates the 
production of the body's natural painkillers called endorphins. 
Anaesthetics 
Preoperative: Epidural Blockade 
When amputation surgery is performed, whether caused by trauma or 
disease, the amputee is often in pain before the surgery commences. It is 
thought that this pain imprints on the brain and creates a "pain path" 
which then causes phantom limb pain after the limb is removed. By using 
an epidural, an injection of anaesthetic to the spine, usually for a 
period of 72 hours prior to the surgery, the message of pain is blocked 
from reaching the brain and creating a "pain path." It has been reported 
that people who have an epidural blockade prior to surgery experience 
less pain during the postoperative period, as well as a reduction in the 
frequency and severity of phantom limb pain. It is also thought that 
the epidural reduces pain by cutting off the pain messages associated 
with the surgery, which still register in the brain even though the 
patient is unconscious. 
Postoperative: Local anaesthetic (examples: Lidocaine, Marcaine, 
Novocaine, Pontocaine, Xylocaine) These medications act on nerve cells by 
making them incapable of transmitting pain messages for a short period of 
time. They may be given as spinal (a small needle into the spinal 
column, in the lower back), epidural (a small needle and catheter into the 
spinal column, in the lower or mid-back), by local injection or a wide 
variety of nerve blocks. These may be used to relieve trigger points and 
reduce stump pain. 
Biofeedback 
Advocates of biofeedback feel that phantom pain may happen because of 
anxiety, which may increase muscle tension and contribute to the pain 
cycle. "Hyperactive muscles" cause irritation in the cut ends of the 
nerves in the residual limb. Electrodes are attached to the residual limb 
which detect when the muscle is tensed and trigger a flashing light or 
buzzer to provide feedback. Once the amputee has become aware of the 
muscle tension they learn to relax the muscle. When an appropriate 
decrease in muscle tension is reached the feedback stops. The focus of this 
treatment is to teach the muscle(s) how to relax, thereby relieving the 
pain. 


Chiropractic 
Some amputees may find relief through chiropractic - which means 
"treatment by hand." Chiropractic does not involve drugs or surgery, but 
instead concentrates on the spine in relation to the total body. Doctors of 
chiropractic, or chiropractors, specialize in the understanding and 
treatment of the different parts of the spine: bone (vertebrae), muscles 
and nerves. When a vertebral joint is not working properly it can create 
an imbalance which disturbs the nervous system. This can lead to excess 
strain being placed on other joints, resulting in some form of pain. 
Through manual adjustment, or manipulation of the spine, chiropractic 
works to correct misalignments of the spine thus alleviating pain. 
Cold 
Applying cold to the residual limb may help alleviate some of the 
discomfort associated with phantom limb pain or muscle spasms. Refreshing 
coolness can be administered through cold compresses, ice packs or cool 
baths. Amputees may also wish to try a cooling cream or gel. One newer 
product available is Biofreeze, which is an analgesic cryotherapy gel 
made from the extract of a South American holly shrub. Biofreeze creates 
a cooling sensation within the skin that can last several hours. 
Another gel, Glenalgesic Blue, is a topical pain fighter for the prompt and 
temporary relief of muscular aches and pains, containing menthol, 
alcohol and camphor. [See also Heat.] 
Cranial Sacral Therapy 
This type of therapy, involving the study of bone and joint 
misalignment related to the head, has been practised by many different cultures 
for thousands of years. Therapeutic touch is applied to the head, and 
meditation and visualization techniques may also be used in conjunction 
with cranial sacral therapy. A therapist treating phantom pain may 
"massage" the missing limb, as well as encourage visualization of the lost 
limb in an effort to help amputees release any sense of grief, loss or 
anger towards the missing limb(s). 
Desensitization 
The nerves in the stump of the amputated limb can be very sensitive, 
especially directly following the amputation. Not only does 
desensitization reduce nerve sensitivity, it can also reduce pain and discomfort 
overall. Rubbing the stump with a piece of terry cloth, gently 
manipulating the stump manually, tapping the stump, or using a vibrator can all 
help to desensitize the nerves, alleviating sensation and pain. [See also 
Massage.] 

Dietary and Herbal Supplements 
Some amputees have found certain dietary supplements or homeopathic 
food products help reduce phantom limb pain. Examples of dietary 
supplements amputees have tried include: potassium; calcium; magnesium, and 
injections of Vitamin B12. Certain herbal products have also been found 
useful by some amputees including juniper berries (interestingly called 
"ghost-berry" by Native Americans). Antioxidants such as Pycnogenol (a 
pine bark extract sold in Canada as a food product) and Grape Seed 
Extract are extremely concentrated bioflavonoids, which until 1936 were known 
as Vitamin P. Antioxidants attack free radicals, which are unstable 
atoms inside our bodies that attack all body tissues, degrade collagen and 
reprogram DNA. Free radicals are believed to be the underlying cause in 
many diseases. Antioxidants are found in high concentrations in grape 
seeds and pine bark, and in lesser amounts in grape skins, cranberries, 
lemon-tree bark and hazelnut tree leaves. Antioxidants are available in 
liq uid and pill form. 
*Amputees should always consult their doctor before taking any 
supplements or herbs, as these are not harmless, but can have powerful side 
effects. They may also interfere or conflict with other medications being 
taken at the same time. 
Electrical Stimulation 
Another theory behind phantom limb pain suggests that it occurs because 
the nerves in the residual limb lack the stimulus once provided by the 
missing limb. One electrical treatment, transcutaneous electrical nerve 
stimulation (TENS), uses low current at a low-frequency oscillation to 
stimulate the nerves and provide pain relief. The amputee feels a 
gentle tingling without increased muscle tension. Depending on the severity 
of pain, the small-battery operated device can be used for 20 minutes 
to a few hours of stimulation, several times daily, and the amputee can 
be taught how and when to apply treatment. Because TENS can cause 
arrhythmia, it should not be used by people with advanced heart disease or a 
pacemaker. Your doctor will advise if this is suitable for you. 
Exercise 
Exercise increases circulation and stimulates the production of 
endorphins (chemicals naturally produced in the brain that kill pain). Many 
amputees find that moderate and frequent exercise can help to reduce 
phantom pain. Flexing and relaxing the muscles on the residual limb also 
helps some amputees. 
Farabloc 
Farabloc is a fabric which contains extremely thin steel threads but 
looks and feels like linen. The makers state that Farabloc has a 
shielding effect from ions and magnetic influences, which protects damaged 
nerve endings. It stimulates blood circulation and produces a pleasant 
feeling of warmth. It can be cut and sewn, washed and ironed like any other 
fabric, and is available in blanket forms of various sizes. People may 
have socks, sheaths, or custom residual limb covers made from Farabloc 
or the material may be incorporated directly into a prosthetic socket. 

Heat 
Applying soothing warmth has been reported to help deal with occasional 
bouts of phantom limb pain. Warm baths, a heating pack, a Magic Bag, or 
wrapping the stump in warm, soft fabric to increase circulation are all 
examples of how heat can be used. There are also rubs and gels which 
generate heat, such as Rub A535 or Tiger Balm. More advanced forms of 
heat therapy can be used under the guidance of a trained professional. 
Some amputees alternate between applying heat and cold. [See also Cold.] 
Keeping a Journal 
Some amputees write down dates and times as well as other factors that 
may be present when they experience phantom limb pain, such as stress. 
A record kept over time may indicate factors that influence or trigger 
the occurrence, frequency or severity of an attack of phantom limb pain 
in the same way that migraine sufferers have found that certain foods 
trigger their migraines. 
Magnetic Therapy 
Magnets have been used for thousands of years to treat many conditions, 
including recently phantom limb pain. Magnetic therapy involves 
applying a magnetic field to the body to relieve pain and speed up the healing 
process. The application of electromagnetic fields have been shown to 
affect cell permeability and improve oxygen delivery to the cells, which 
can lead to better absorption of nutrients, improved circulation, and 
clearance of waste products. Magnets may also reduce inflammation and 
pain, and promote healing. The magnets are usually incorporated into 
bracelets, belts, or fabric straps, and are available in differing 
strengths and sizes. These products are available from several companies such 
as Nikken and Bioflow. (It is recommended that you consult your doctor 
before trying magnetic therapy to ensure it is a good choice for you.) 
Massage 
Massaging your limb is a good way to increase blood-flow and 
circulation, which may help to alleviate some discomfort. Massage may also help 
to reduce swelling and loosen stiff muscles, which can provide some 
relief from pain. 
Medications 
Medications are useful in the treatment of pain (especially chronic 
pain). However, many amputees prefer to try other avenues of relief first. 
It is important for the amputee to understand all the possible 
side-effects of over-the-counter and prescription medications, including the implications of long-term use. 

Anti-Inflammatory Drugs (examples: acetaminophen [Tylenol], aspirin, 
ibuprofen [Advil, Motrin] 
Acetaminophen, aspirin and ibuprofen are all examples of medication 
which can reduce mild swelling or soreness, and are useful for mild to 
moderate pain. They are non-addictive and may be effective for occasional 
bouts of phantom pain. One amputee uses Tylenol Arthritis Pain for 
relief from his phantom limb pain. 
Antidepressants (examples: Amitriptyline, Elavil, Pamelor, Paxil, 
Prozac, Zoloft) 
Developed to treat depression, many antidepressants have been found to 
be useful in the treatment of many chronic pain conditions, including 
phantom limb pain. These drugs work centrally on the brain to either 
block or increase certain chemicals that help regulate normal brain 
function. 
Anticonvulsants or anti-seizure medications (examples: Tegratol, 
Neurontin) 
These drugs have also been found useful in the treatment of phantom 
limb pain. They act directly on the nerves both in the residual limb and 
in the brain to alter neurotransmission, thus calming nerves in the 
residual limb which may have become over-active following amputation. These 
drugs are prescribed in small doses and are gradually increased to a 
level which promotes relief. It is also very important to decrease the 
dose gradually before ceasing to take the medication. 
Narcotics (examples: Codeine, Demerol, Morphine, Percodan, Percocet) 
These drugs mimic the pain killing chemicals released by the brain in 
response to pain. While they are very effective as temporary solutions 
for pain after surgery, trauma, or to treat cancer pain, they are highly 
addictive and in the majority of cases should not be used for a 
prolonged period. Amputees who have only an occasional severe attack of 
phantom pain may benefit from a limited course of this type of drug. When 
these drugs are taken on a regular basis the patient becomes addicted and 
desensitized to the drugs, requiring more of the drugs while achieving 
less effective pain relief. 

Meditation 
Both physical and mental tension can make pain worse. Meditation may 
help to reduce phantom limb pain by relaxing tense muscles and lowering 
anxiety levels. The aim of meditation is to produce a state of relaxed 
but alert awareness, this is sometimes combined with vizualisation 
exercises that encourage people to think of pain as something remote and 
separate from themselves. 
Psychotherapy 
Some amputees may find individual or group therapy beneficial. Some 
have even tried hypnosis. Trained professionals can help amputees learn 
coping skills and can provide psychological and emotional support for 
dealing with pain. 
Shrinker Socks 
Bandaging and shrinker socks apply even pressure to the residual limb 
which may help to reduce or alleviate phantom limb pain. 
Wearing Your Artificial Limb 
As well as improving circulation, putting on your artificial limb and 
moving around may also help alleviate phantom limb pain.