Phantom pain

Of the Phantom pain, which is also called Phantom limb is known to be a pain especially with missing or amputated limbs. Although the body parts are no longer there, those affected feel pain. In addition to residual limb pain, phantom pain also belongs to amputation pain.

What is Phantom Pain?

Even in the ancient high cultures of mankind, for example in ancient Egypt or the South American Mayans, doctors amputated sick or injured limbs. In ancient times, gangrene was a common cause of amputation of an arm or leg and was often the only hope of saving a human life.

Even today, limbs sometimes have to be amputated, for example due to irreparable damage from an accident or an infectious disease.

An estimated 50 to 80 percent of patients who have had a limb or organ removed then complain Phantom pain or phantom sensations in the now missing parts of the body.

Phantom pain usually occurs within a month after the operation and the intensity of the pain varies. In rare cases, however, those affected may only complain of phantom pain for months or years.

causes

Science could not yet find any concrete causes for the occurrence of the phenomenon Phantom pain Find. A few years ago it was still believed that the reason for the virtual pain was inflamed nerve stumps. Doctors now believe that phantom pain is due to some kind of confusion in the brain.

Even after the amputation, the brain has not yet classified the limb or organ as missing and simply continues to use the old, complete body scheme. This approach also explains why phantom sensations occur: For example, some patients think they can gesticulate with a missing hand.

Another observation supports the thesis of the brain, which cannot rethink: phantom pain depends in its intensity on the pain actually felt before the operation. The patients' brains seem to remember the real pain they experienced before the operation.

Some people claim phantom pain when the weather changes from former wounds or fractures, e.g. from high pressure to low pressure, to feel. However, this cause has not yet been scientifically verified and therefore represents a subjective sensation.

Symptoms, ailments & indications

Patients can usually indicate exactly where they feel the phantom pain. A person whose right forearm was amputated could feel the phantom pain, for example, in the (now missing) heel 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 a corresponding neural stimulus were present. The pain is not simulated and does not occur directly on the stump.

Basically, phantom pain can develop in any part of the body that has been amputated. However, the symptoms occur particularly often when the surgical site is close to the trunk. Phantom pain often occurs in phases. Continuous pain is also possible, but is less common. Both the pain attacks and the permanent phantom pain represent a burden that often leads to psychological complaints.

Both the intensity and the quality of the pain can vary. Phantom pain can feel stabbing, cutting, or burning. Those affected can also have the impression that they have a painful cramp in the amputated part of the body.

Some patients experience phantom pain immediately after the amputation. In other cases, the symptoms take a long time to appear. Most people develop phantom pain within the first month after surgery. However, the symptoms can also appear for the first time after several years.

Diagnosis & course

Of the Phantom pain is diagnosed primarily on the basis of patient descriptions. Before committing to this diagnosis, however, the doctor must first rule out organic causes of the pain. So-called stump pain also occurs frequently after an amputation and is sometimes difficult for the patient to distinguish from phantom pain.

Stump pain is often triggered by pressure sores caused by poorly fitting prostheses, by inflammation or circulatory disorders. Phantom pain usually comes in the form of flare-ups or attacks.Rarely are they described as being permanently present.

The type of pain can be very different: patients reported sharp, burning, cramp-like, stabbing or cutting phantom pain. Phantom pain also differ in intensity and duration. Some people suffer from it so badly that they want to take their own lives.

Complications

Phantom pain after an amputation is common, affecting around 70 percent of all those affected. It is normal to some extent and is often associated with stump complaints. Even if phantom pain is harmless in most cases, a doctor should still 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 what is known as a pain memory. In this case, signals are sent from the brain to the amputated area of ​​the body and there is no response. If this happens several times, the brain classifies the lack of 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 severe and require pain medication. Long-term use of pain killers, however, harbors the risk of becoming dependent on pain killers. In addition, phantom pain can cause irritability and sleep disorders, and it can affect both health and social life. Without treatment, depression or even mental illnesses that require treatment can also occur.

When should you go to the doctor?

Phantom pain is suffered by people who have lost body parts. Other people do not belong to the risk group of this unpleasant pain experience. If the person concerned notices discomfort in areas of the limbs that have been severed by an accident or an amputation, they should consult a doctor. In these cases, therapeutic work with various exercises and training sessions is required so that the necessary reprogramming in the brain can take place. Otherwise, the symptoms will persist or increase in intensity. A doctor should be visited so that a therapy plan can be drawn up.

A doctor should be consulted in the event of insomnia, persistent stress, inner restlessness and impairment of the joy of life. If there are vegetative dysfunctions, changes in personality, general dissatisfaction or a restriction in lifestyle, a doctor is required. Depressive moods, indifference or behavior problems should also be discussed with a doctor. Concentration disorders, attention deficits and a decreasing resilience are signs of a health impairment.

A doctor should be consulted so that the symptoms can be alleviated. The intensity of the complaints often varies. There can also be a phase of freedom from symptoms. Normally, no doctor is required during these times. However, if the pain returns after a certain period of time, it is advisable to consult a doctor.

Treatment & Therapy

There is no single treatment option against Phantom pain. Possible therapies must be individually tailored to each patient and should help the brain to reorganize. As a rule, phantom pain is treated with medication, physical or psychosomatic therapy or a combination of some or more of the options mentioned.

Severe cases of phantom pain are first treated with anesthetic opiates, such as morphine, to alleviate the patient's suffering. Treatment with antidepressants and / or electrical stimulation is common. An electrode placed under the skin stimulates the spinal cord with electrical impulses that are intended to distract the brain from the phantom pain.

Newer methods such as mirror therapy and therapy using virtual reality seem to be very successful. Both therapies simulate the amputated limb and ask the patient to move it and thus free it from its painful position. Targeted distraction and other occupation 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 shortening the stump, severing the sensory nerves in the spinal cord and removing the thalamus are no longer common. They usually showed little or no success.

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Outlook & forecast

The prognosis for phantom pain depends on certain factors. It is especially important to start medical treatment for pain as early as possible. If the pain treatment is positive, about 70 to 90 percent of all affected people experience a favorable course of the symptoms. However, if pain therapy is started at a later point in time, the outlook is less favorable. Only one third of the patients show a positive healing process.

How long the phantom pain lasts cannot be said in principle. So there is a chance that the pain will go away spontaneously. A sudden return of the painful symptoms is also possible. The prognosis is particularly unfavorable if the patient has been suffering from amputation pain for more than six months.

The type of amputation pain plays an important role in the further course of the symptoms. Immediately after the operation, abrupt residual limb pain suddenly set in, which in some cases can become chronic. However, they are often acute and severe. In the case of phantom pain, the symptoms can generally be expected to persist for a longer period of time. In addition, the pain can reappear at any time.

Sometimes phantom pain occurs as a result of inflammation or infection. The prognosis can usually be improved by giving antibiotics.

prevention

Phantom pain is difficult to prevent. In many cases, however, the administration of neuroleptics or analgesics before a planned operation has proven to be helpful. Phantom pain did not appear as severe or in some cases not at all.

Aftercare

With suitable therapy, phantom pain subsides in the first few weeks after an amputation. Many patients do not need any follow-up care because they have no symptoms. Subsequent acute discomfort is not uncommon, but can usually be remedied without consulting a doctor. However, if there are recurring attacks of pain or a constant feeling of pain, follow-up care is essential.

The scope of the follow-up depends on the intensity of the complaints. Long-term treatment with medication is not uncommon. Alternative healing methods are sometimes promising. Depending on the severity of the symptoms, psychotherapy may be indicated. The teaching of relaxation exercises often also helps.

Some people suffer from their condition so badly that they attempt suicide. The controls and treatments serve to identify and address life-disregarding tendencies in the early stages. As part of the aftercare, the patient's feelings are primarily reflected.

Physical examinations serve to rule out other diseases. The attending physician documents the effect of the therapies carried out. What promises success is continued, what does not lead to improvement is discarded. Doctors cannot prevent phantom pain because of its unpredictable occurrence. As is usual with tumor diseases, follow-up care cannot have a preventive character.

You can do that yourself

People who suffer from phantom pain can improve their symptoms through cognitive approaches. Since pain is stored in the brain based on experiences and is not based on a real impact, training can bring about a relief of pain. It is helpful to use and support a therapist. Together with him, exercises can be worked out, which the person concerned can carry out independently in everyday life as required.

Mirror therapy approaches are helpful and very promising. They represent an enormous relief for the patient and improve the well-being considerably. In consultation with the therapist, the training units can be carried out independently between or after the treatments. With dexterity exercises in front of a mirror, sensory impressions are evoked, which help in coping with pain.

In addition, awareness processes are helpful when dealing with the changed situation. Since it is an imagined pain, some patients manage to change their stored memories in a targeted manner by dealing with them. Cognitive techniques offer possibilities and methods that can also be used independently by the patient in everyday life. Phantom pain should not be ignored, as this can lead to an intensification of the symptoms and considerable impairments in everyday life.