Phantom Pain

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Phantom pain

Phantom pain is attributed to changes in the brain. They are felt in a part of the body that is no longer there, usually as a result of an amputation. Most of those affected continue to feel the body part that is no longer there (e.g. arm or leg), for example its shape (length, girth) and posture. In addition, there are tingling sensations, sensations of touch or twitching and above all pain (in 60 to 80 percent of amputees).

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What are the causes of phantom pain?

Phantom pain is attributed to changes in the brain. In the sensorimotor cortex ("tactile cortex") - the inner map on which all body regions are represented according to the sensation messages they send - the amputated part of the body in patients with phantom pain is still shown. However, there is a reorganization of this brain region, in which touch and pain stimuli are processed. This is because the portion of the “sensory map” that received nerve impulses before the amputation remains without an influx after the operation. However, it does not remain empty, but receives impulses from neighboring regions after the amputation. The following applies: the greater this reorganization, the greater the phantom pain.

Regions in the brain that have more to do with the emotional component of pain, ie the assessment of how uncomfortable the pain is, can also change. This reorganization in the brain is particularly pronounced when pain occurred in the affected part of the body before the amputation and this has left a kind of central pain memory. Then, after the amputation, pain-inhibiting mechanisms may be lost and, with it, previous pain in the phantom limb may occur.

How is phantom pain treated?

Some successes can be achieved with medicinal approaches, especially with antidepressants, opioids and preparations that change the excitability of the brain. Due to the changed representation of body parts in the tactile cortex, it makes sense to start pain therapy right here, ie to reverse the reorganization in the brain. This is possible with different methods:

• Myoelectric prosthesis: By wearing the prosthesis, the region of the brain that was changed due to the amputation is reactivated. The function of the lost limb is partially restored, the brain receives stimuli, and the negative remodeling processes are reversed.
• Sensory perception training: Here, the stimulation of the residual limb is combined with conscious perception of the stimuli, which has a beneficial effect on both the pain and the remodeling processes.
• Mirror training: If the patient moves the limb that is still present in front of the mirror, this is perceived as a movement of the amputated limb through the reflection. The representation in the tactile cortex normalizes; phantom pain is reduced.
• Visualizations: Imagination exercises on movements of the phantom limbs also lead to similar successes.

Which form of therapy is suitable in individual cases should be clarified in an interdisciplinary pain clinic or clinic.