Busting the Myth of Phantom Pain Disorder
Phantom pain was once thought to be purely psychological, but new research has debunked this myth and is getting closer to the truth of this elusive condition…
Amputation is a surgical procedure where a part of the body has to be removed to treat a serious medical condition. Often, it’s a last resort due to a delay in medical treatment, and affected individuals spend the rest of their lives dealing with the repercussions. Phantom pain is one of these repercussions.
Phantom pain has been a recorded phenomenon since it was described by French military surgeon, Ambroise Pare, in the sixteenth century. The condition involves pain in amputated limbs, almost as if the limb is still there.
In this article we’re going to cover what phantom pain is, and its common symptoms. We’ll then discuss how medical science has moved beyond the myth that “it’s all in your head”, as well as the various treatments used to relieve it.
What is Phantom Pain and What are the Symptoms?
Phantom pain appears to exist in a body part that is no longer there. For the longest time, this pain was treated as a psychological problem, but new research has shown that these sensations originate in the spinal cord and brain.
There is also a condition known as phantom limb sensation, where the person feels that their limb is still there but there’s no pain in it. Most people who lose a limb feel this sensation but it’s not the same as phantom pain.
Symptoms of Phantom Pain
The typical symptoms of phantom pain are:
- Pain within the first week after amputation (sometimes this can take months to appear) that feels like it’s in your missing limb
- Sporadic or continuous pain
- Pain in the part of the limb farthest from the body, such as the foot of an amputated leg or the hand of an amputated arm
- Various types of pain that could be described as shooting, stabbing, cramping, pins and needles, crushing, throbbing, or burning
Everyone’s pain is different with phantom limb syndrome, so the main test is that the pain feels like it’s in the missing limb.
The Phantom Pain Myth Debunked
Now it’s time to delve into the causes of phantom pain. The main purpose of this section is to debunk the theory that the condition is purely psychological, but also to give you an outline of the latest theories on how the condition develops.
Myth: “It’s all in Your Head”
Early theories on the underlying cause of phantom pain were based around it being imagined or “in the head”.
An apparent similarity to phantom illusions experienced in a psychotic state led professionals to believe phantom pain was purely psychological or imaginary. The reason someone with an amputated limb felt pain was because they weren’t dealing with the loss very well, and it manifested as physical pain.
This theory was not universal, though. In fact, there were doctors, such as George Riddoch, who treated spinal patients in the First World War and was surprised the medical profession refused to acknowledge a physiological basis for phantom pain. Riddoch reported that many patients were reluctant to discuss their phantom pain for fear they would be thought insane.
Thankfully, in 1987, a review of the literature relating to the psychological factors of the condition concluded the opposite. It stated that there was no evidence to suggest that these factors had anything to do with phantom pain, and they were not more prevalent in people with the condition.
New Theories on Phantom Limb Syndrome
There are multiple up-to-date theories on the causes of phantom pain, most of which are based on physiological factors and not psychological ones. The only agreement of these theories is that there are multiple mechanisms responsible for the condition.
For years the predominant theory involved the irritation of severed nerve endings, due to the fact that almost all amputation patients develop neuromas in the residual limb. Over the last few decades, however, advances in imaging and lab techniques have shown that the central nervous system is heavily involved in phantom pain.
MRIs and PET scans have shown activity in the areas of the brain associated with the lost limb whenever the patient feels the phantom pain. This has led to the conclusion that many peripheral and central nervous system factors are responsible for the condition.
The Studied Mechanisms Involved in Phantom Pain
Now that scientists and doctors have looked into the physiological causes of this condition, it’s clear to see that there are many neurological mechanisms involved. Here’s a quick rundown of these mechanisms, to help you get to know the details better:
- Peripheral nerve changes: trauma in the nerves takes place during amputation which disrupts the normal signals from the missing limb. Neuromas form, and the nerves become excitable and discharge spontaneously.
- Spinal cord changes: neural activity increases in the spinal cord and nerves become hypersensitive. The increased activity and a decrease in inhibitory activity due to the lost limb can cause phantom pain.
- Brain changes: areas of the brain’s cortex that represent the amputated area are taken over by neighbouring regions, and this can cause stimulation in the residual limb that feels like pain in the part that’s missing.
- Psychogenic factors: these factors are somewhat psychological, as phantom pain can often develop into chronic pain syndrome. Because of this, the patient’s psychological issues need to be addressed for the treatment to have a high chance of success. Depression, anxiety and increased stress are all triggers for phantom pain.
Phantom Pain Treatment
Now that we’ve busted this myth, it’s time for a brief overview of effective treatments for phantom pain, so you have an idea of how to treat it if you have it.
There are no medications specifically designed for phantom pain treatment, but some drugs designed to treat other conditions are helpful in relieving nerve pain. Not all of these medications work for everyone, so you might have to try a few before you find one that works for you. These medications include:
- Over-the-counter (OTC) pain relievers: acetaminophen, ibuprofen or naproxen sodium.
- Antidepressants: tricyclic antidepressants, such as amitriptyline, nortriptyline and tramadol.
- Anticonvulsants: epilepsy drugs such as gabapentin and pregabalin.
- Narcotics: opioid medications, such as codeine and morphine.
- N-methyl-d-aspartate (NMDA) receptor antagonists: this class of anaesthetics binds to the NMDA receptors on the brain’s nerve cells and blocks the activity of glutamate, a protein that relays nerve signals.
All of these drugs should only be taken under the instruction of your doctor. Be sure to set up a consultation and prescription before trying any of these pain medications.
As with medications, treating phantom pain with therapy is a matter of trial and error. The following methods may relieve phantom pain:
- Mirror box: a box with mirrors that make it look like your amputated limb is still there. You then perform symmetrical exercises, and pretend the intact limb is on the amputated limb.
- Acupuncture: the National Institute of Health has found that acupuncture can relieve some types of chronic pain. In acupuncture, the specialist inserts very thin, sterilised needles into the skin at particular points on the body.
- Repetitive transcranial magnetic stimulation (rTMS): this therapy places an electromagnetic coil against your forehead, and short pulses are sent through it to create small electrical currents in the nerves located in a specific area of your brain.
- Spinal cord stimulation: tiny electrodes are inserted along your spinal cord and a continuous small electrical current is delivered to relieve pain.
Some of these treatments may work for you, and some of them won’t. They are all meant to relieve pain, and are not cures for phantom pain.
That said, as medical science advances in this area, hopefully a cure will arise, and these treatments will no longer be necessary. New technologies that allow us to study the brain and nervous system in greater detail will help us realise the causes. Then, we can hopefully find a cure for the 60 to 90 percent of amputees who suffer phantom pain symptoms.
What Does the Future Hold for Phantom Pain?
In this article we’ve covered everything you need to know about phantom pain syndrome, and dispelled the erroneous myth that the cause is purely psychological. At least we can thank the myth for giving scientists a reason to look into the condition. Now, it appears we might be on the forefront of discovering exactly what causes phantom pain.
We hope you found this post interesting and useful. Our aim is to keep you informed on what may lie ahead for you, as an impaired individual. We hope this has laid bare some of the misconceptions surrounding phantom pain, so we can all support one another in the most informed way possible.