Diagnosis

Although there's no medical test to diagnose phantom pain, doctors identify the condition based on your symptoms and the circumstances, such as trauma or surgery, which occurred before the pain started.

Describing your pain precisely can help your doctor pinpoint your problem. Even though it's common to have phantom pain and residual limb pain at the same time, treatments for these two problems may differ — so an accurate diagnosis is important.

Treatment

Finding a treatment to relieve your phantom pain can be difficult. Doctors usually begin with medications and then may add noninvasive therapies, such as acupuncture.

More-invasive options include injections or implanted devices. Surgery is done only as a last resort.

Medications

Although no medications specifically for phantom pain exist, some drugs designed to treat other conditions have been helpful in relieving nerve pain. No single drug works for everyone, and not everyone benefits from medications. You may need to try different medications to find one that works for you.

Medications used in the treatment of phantom pain include:

  • Over-the-counter (OTC) pain relievers. Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) might relieve phantom pain. Take these medications only as directed by your doctor. Overuse can cause serious side effects, such as stomach bleeding.
  • Antidepressants. Tricyclic antidepressants may relieve the pain caused by damaged nerves. Examples include amitriptyline, nortriptyline (Pamelor) and tramadol (Conzip, Ultram). Possible side effects include sleepiness, dry mouth and blurred vision.
  • Anticonvulsants. Epilepsy drugs — such as gabapentin (Gralise, Neurontin) and pregabalin (Lyrica) — may be used to treat nerve pain. Side effects may include dizziness, sedation and mood changes.
  • Narcotics. Opioid medications, such as codeine and morphine, may be an option for some people. Taken in appropriate doses under your doctor's direction, they may help control phantom pain.

    However, you may not be able to take them if you have a history of substance abuse. Even if you don't have a history of substance abuse, these drugs can cause many side effects, including constipation, nausea, vomiting or sedation.

  • N-methyl-d-aspartate (NMDA) receptor antagonists. This class of anesthetics works by binding to the NMDA receptors on the brain's nerve cells and blocking the activity of glutamate, a protein that plays a large role in relaying nerve signals.

    In studies, NMDA receptor antagonists ketamine and dextromethorphan helped relieve phantom pain. Side effects of ketamine include mild sedation, hallucinations or loss of consciousness. No side effects were reported from the use of dextromethorphan.

Medical therapies

As with medications, treating phantom pain with noninvasive therapies is a matter of trial and observation. The following techniques may relieve phantom pain for some people:

  • Mirror box. This device contains mirrors that make it look like an amputated limb exists. The mirror box has two openings — one for the intact limb and one for the residual limb.

    The person then performs symmetrical exercises, while watching the intact limb move and imagining that he or she is actually observing the missing limb moving. Some studies, though not all, have found that this exercise may help relieve phantom pain.

  • Acupuncture. The National Institutes of Health has found that acupuncture may ease some types of chronic pain. In acupuncture, the practitioner inserts extremely fine, sterilized stainless steel needles into the skin at specific points on the body. Acupuncture is generally considered safe when performed correctly.
  • Repetitive transcranial magnetic stimulation (rTMS). This therapy uses an electromagnetic coil placed against the forehead. Short pulses are sent through the coil that cause small electrical currents in the nerves located in a specifically targeted area of the brain.

    Research suggests that this therapy may be helpful for phantom pain, though it isn't yet specifically approved for this condition. The magnetic field is similar to the one used in MRI scans. Side effects may include a mild headache or lightheadedness.

  • Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered continuously to the spinal cord can sometimes relieve pain.

Surgery

Surgery may be an option if other treatments haven't helped. Surgical options include:

  • Brain stimulation. Deep brain stimulation and motor cortex stimulation are similar to spinal cord stimulation except that the current is delivered within the brain. A surgeon uses a magnetic resonance imaging (MRI) scan to position the electrodes correctly. Although the data are still limited and these treatments aren't specifically approved for phantom pain, brain stimulation appears to be a promising option in selected individuals.

Potential future treatment

Newer approaches to relieve phantom pain include virtual reality goggles. The computer program for the goggles mirrors the person's intact limb, so it looks like there's been no amputation. The person then moves his or her virtual limb around to accomplish various tasks, such as batting away a ball hanging in midair.

Although this technique has been tested only on a small number of people, it appears to help relieve phantom pain.

Lifestyle and home remedies

You may not have control over whether you develop phantom pain after surgery, but you can reduce your discomfort and improve your quality of life. One or more of these approaches may help you get through a flare-up of phantom pain:

  • Look for distractions. Find activities that take your focus off the pain, such as reading or listening to music.
  • Stay physically active. Get your exercise by doing activities that you enjoy, such as gardening, walking, swimming or cycling.
  • Take your medications. Follow your doctor's directions in taking prescribed and over-the-counter pain medications. If you try herbal and other alternative medications, be sure to tell your doctor.
  • Find ways to relax. Practice activities that reduce your emotional and muscular tension. Take a warm bath — not too hot, as heat may aggravate the pain. Lie down and follow helpful relaxation techniques, such as rhythmic breathing, meditation or visualization.
  • Seek support from other people. Find ways to get closer to others. Call friends, or join a support group or a group involved in your favorite hobby.

Remember that managing phantom pain can make a big difference in how you feel. If one approach doesn't provide relief, try something else rather than give up.

Coping and support

Learning to live without a limb, especially if you have phantom pain, can be challenging. Depression often accompanies pain. You may find it helpful to talk to a counselor or therapist.

An in-person or online support group can put you in touch with others who know what you're going through. To find support, ask your doctor for a referral, either to a counselor or to a support group.

You can also contact the Amputee Coalition at www.amputee-coalition.org for information on its National Peer Network, which can put you in touch with a variety of support services, including its Peer Visitor Program. This program can connect you with someone who's been in your place and can talk to you about healing, share his or her experiences, and offer advice.

Oct. 30, 2018
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