Phantom Pain: The Feeling Is As Real As It Can Get!
Phantom pain is a sensation that various individuals perceive towards a part of the body or an internal organ that doesn’t exist. This phantom pain occurs usually when people undergo an amputation surgery. In other cases, it can also happen from birth, in those who are born with a birth defect or a congenital disorder. Sometimes, phantom pains can appear as a result of an injury to the spinal cord or avulsion. Avulsion means that a structure of the body becomes disconnected from the body. This can happen due to a surgical procedure or because of trauma when body parts like ears become removed from the body.
Some people may experience phantom pain for just a short amount of time. The pain will leave by itself eventually. On the other hand, other people might suffer for a long time. The pain is intense and extreme and they keep on suffering. If you or anybody you know might be experiencing phantom pain, do let your doctor know. A physician will be able to reduce the symptoms and provide treatment. And the sooner you get treatment for phantom pain, the better.
What is Phantom Pain?
What science knows of so far is that the majority of the people who lose a limb as a result of an accident, surgery etc. will experience a phantom limb.
This very realistic perception that the limb is still there happens quite often, apart from that it can still cause pain to those who experience it.
However, what is interesting about the phantom limb pain, is that one doesn’t necessarily need to have had a surgery to experience the effects. Maybe not the full effects and the full experience of what a real phantom pain feels like, but it can definitely come close enough. In order to understand the following example and the phantom pain, we need to say a few words about body proprioception and body ownership.
Phantom pain: Proprioception and body ownership
Body proprioception is the way we perceive each and every single one of our body parts. We know where our body parts are located to a relative degree. We are also able to subconsciously understand how strong we are which helps us with motor skills and movement. Concepts like muscle memory, hand-eye coordination are quite common in the everyday language. Both of them come from this sense of ownership of what each and every single one of us is.
Some scientists even call proprioception as the sixth sense. The other five senses that we know of – touch, hearing, sight, smell, and taste – provide us with the information from the outside world. Because of the five senses, we are able to perceive the world around us as a unified concept. In an everyday life we don’t just experience one thing at a time, however a multi-sensory integration of all. Proprioception, however, comes from the inside. Scientists call it the sixth sense because people are able to sense what is going on inside our bodies. We know the stimuli that start within our bodies, we understand our relative position in space, our range of motion and our equilibrium. We are aware of our limbs and body parts.
When we pass through a crowded area, we turn at the right moment and attempt to make ourselves smaller. We do that due to the fact that we subconsciously know how much space we occupy. We know that if we go straight on we will hit that nice lady on the left. If we move a little bit to the right, however, we will push the man in the hat who is reading his newspaper. We understand all of this because of proprioception.
Now that we understand a little bit more about body ownership and how we perceive ourselves, it’s time to go back to the example.
Phantom pain: Rubber Hand Illusion
As we have established, phantom pain involves vivid sensations in a lost limb. The general public, however, is able to experience similar sensations without losing a limb. Rubber hand illusion has a lot to do with that concept of proprioception and body ownership and you will see the link with the phantom pain in just a bit.
Ehrsson colleagues in their 2004 study explored the ownership that we as people have of our hands. We know that the hands we are looking at are ours. We can move them in every way possible, we can control the fingers, move each hand individually or clap them together. It is fully ours. Could we trick the brain into thinking another hand could be ours too? That’s the basic concept of the rubber hand illusion.
Phantom pain: Body ownership?
The illusion itself is quite ingenious. The participant will have to place both of their hands on the table, one on each side of a screen. The screen blocks the participant from seeing the left hand outside of the screen. A realistic looking rubber hand goes inside the screen. When the participant looks at the table, he or she will see their real right hand on the table and beside it the left rubber hand because their real left hand is on the outside of the screen, invisible to them. After this, the real experiment begins. The researcher will start by slowly stroking the rubber hand and the hidden left hand with a small brush. He does so in similar strokes on both hands, on the same finger and at the same pace.
The subject will see the scientists stroking the rubber hand but also feel the same stroke on their hidden left hand. After this goes on for a few minutes, the subject will start feeling like the rubber hand is part of their own body and he or she feels the strokes on the rubber hand. The scientist usually ends the illusion by hitting the rubber hand with the small hammer. Interestingly enough, the participant will usually flinch or let out a shock sound due to the fact that they truly felt like the rubber hand was their own.
This rubber hand illusion is a very common one among scientists and brings a lot of insight into our own view of body ownership. Do we really know that much about ourselves? How do we create our self-image? And what does it say about people who experience phantom pain?
Phantom pain: a little background
According to the analysis by Weinstein SM, the first mention of the phantom limb pain occurred in the 16th century, by Ambrose Pare who happened to be a military surgeon.
Elan D. Louis and George K. York in mentioned that the term ‘phantom limb pain’ was coined by Weir Mitchell, who also happened to be a surgeon but at a different timeline. In the 19th century, he practiced during a Civil War and managed to give a description of phantom pain in detail.
Phantom Pain types
Phantom pain can appear in a variety of different ways and it’s important to recognize and understand the differences between them. Identifying what it is will surely help with faster diagnosis and an easier and faster approach to treatment. The differences might come from the variation in sensations that a person might feel.
- Movement perception where the limb used to be
- Noticing the weight of the phantom limb
- Feeling the length of the phantom limb.
- Feeling different senses where the phantom limb is situated – itchiness, touch, pressure.
As you can see, there are no clear cut differences between types of phantom limbs. Those who suffer from it may experience a variety of things. Sensations help us differentiate between the different types of phantom pain.
Phantom pain: Signs and Symptoms
There is a variety of symptoms that can pop up as a result of phantom pain. As mentioned before, the majority of the people will experience some symptoms if they have an amputation surgery. The sensations that can occur during the phantom limb experience include but are not limited to:
These sensations are phantom limb sensations and are quite common after an operation. Phantom pain is a bit more severe. Just feeling pain from where the amputation occurred is not a symptom of phantom pain.
When the pain feels like it comes from a part of the body that doesn’t exist anymore, that’s what we call phantom pain. Few things can signify the appearance of phantom pain:
- It can be prolonged or it can show up and leave at any moment.
- It happens very shortly after the amputation occurs.
- People describe the pain as pulsating and vibrating and burning.
- People feel the phantom limb being put at an angle that bothers them and a position that brings discomfort.
- The phantom pain usually happens in the part of the body that seems to be the most remote one from the body. Common examples include a leg or a foot
- The phantom pain can be the cause of stress
- The phantom pain can start as a result of pressure upon the limb that is left-over after the surgery.
Phantom pain: Causes and Risk Factors
As we mentioned before, the main risk factor for phantom pain still is surgery that results in amputation. The origin of the sensation of phantom pain, however, still remains a mystery. We do not know where it comes from, however, scientists speculate the involvement of certain brain regions and the spinal cord specifically.
Phantom pain: Causes
Different studies have used a variety of neuroimaging methods in order to see the activity that happens during a phantom pain sensation. They were able to discover certain brain areas of interest. A bit of a disturbance between brain connections in the brain might be the reason for the origin of a phantom brain. The signals can become mixed up together due to a sudden loss of a body part and the loss of input from that area. A lot of scientists put it down toward neuroplasticity that has gone wrong. Due to the fact that the brain and the spinal cord stop receiving input from a certain area, the brain tries to compensate and realize what happens and triggers a pain sensation in the lost limb.
Of course, we cannot forget about certain physiological factors like scar tissue, memory of the pain before the amputation and the damage done to nerve endings in the affected area.
Phantom pain: Risk factors
Apart from the obvious amputation surgery, there are a few other risk factors that can play a role in developing phantom pain. Doctors during the surgery should be aware of these risk factors and attempt to minimize the potential for developing phantom pain.
- Stump pain: a lot of stump pain can contribute to the development of phantom pain due to the damage to the nerve endings.
- Bad prosthetics: your doctor needs to show you the correct way to utilize the prosthetics. He needs to make sure it fits you and you know all the little details about it.
- Painful sensations before the surgery: people are more likely to develop phantom pain if they experience pain in the limb beforehand; remembering that pain can contribute significantly to it.
Phantom pain and the Nervous system
In order to understand phantom pain, understanding of the nervous system is important. Many scientists believe that neuroplasticity plays a big role in the development of phantom pain.
Neuroplasticity is quite a famous concept nowadays and a lot of research goes into it. It talks about how the brain is able to form new connections between neurons over the course of a lifetime. Neuroplasticity seems to be responsible for the compensatory effect of diseases and injuries. It allows the brain to re-adjust the functions and certain stimuli responses that come from the outside. Wall and his colleagues explored the notion of neuroplasticity in their 1977 study. They found that the receptive field of certain neurons changes after partial cut off from the nerve supply. Many other studies show the reorganization of the somatosensory cortex following denervation or some sort of damage. That’s why many scientists believe in neuroplasticity as one of the major contributors to the formation of phantom pain.
Neuroplasticity is supposed to lead to benefits and good reorganization in the brain. Many scientists believe that in phantom pain specifically neuroplasticity becomes maladaptive.
Other scientists disagree with the neuroplasticity view. Makin and colleagues in their 2013 study say that plasticity as a result of phantom pain and not the other way around. They looked at different individuals with amputations who have phantom pain. They found that these people actually have very strong cortical representations of the lost limb. Furthermore, they could not find re-organization of cortical representations. In fact, they found that the differences between the brains of amputees and those of non-amputees do not differ and showed similar brain activity. Of course, the sensorimotor cortex played a big role and Makin and colleagues mention it. They say that certain disconnection showed up between the parts responsible for touch and movement processing and some sensorimotor cortex parts and it linked to phantom pain.
Phantom pain: Peripheral Nervous System
Various studies mention the role of the peripheral nervous system in the formation of phantom pain. The nerve endings are disconnected during an amputation surgery. Because of this, neurons become injured and the input to the spinal cord doesn’t work properly anymore. Certain changes happen in the spinal cord. The disconnected nerves cause certain hyper-excitability and this could potentially cause phantom pain.
Phantom pain treatment
There is a variety of different therapeutic techniques that can decrease the symptoms of phantom pain and help cure it. Certain pharmacotherapy approaches should be looked at.
First of all, analgesia and anesthetics should be used before the surgery. This could prevent the phantom pain from appearing in the first place. It could also decrease the symptoms due to the patient remembering the pain.
Here are some of the most common drugs used for the treatment of phantom pain. Make sure to consult with your physician before taking any medication!
- Anti-inflammatory drugs: some of the most common medications for phantom pain. These drugs are involved in various brain pathways (e.g. serotonin)
- Opioids: these drugs are able to bind with central and peripheral postsynaptic opioid receptors and they are able to provide pain relief. Can also help with the side effects of neuroplasticity that are believed to play a role in phantom pain.
- Tricyclic antidepressants: these drugs can cause pain relief due to the fact that they affect hormones that send out pain signals.
- Anticonvulsants: these drugs are used for seizures but they can help with nerve damage and pain.
Non-pharmacologically, patients may undergo mirror therapy proposed by Ramachandran and Rogers-Ramachandran in their 1996 study. In this technique patients will attempt to restore the proper visual and proprioceptive disengagement that happens in the brain. Surgical intervention may be needed if all other therapeutic strategies fail.
Phantom Pain: Life style and caring
It can be quite difficult living with constant pain in the lost limb. There are certain steps you can take if you or a loved one are experiencing the symptoms. These steps might be able to reduce the symptoms or at least distract you enough until you get proper treatment.
- Support: it is very crucial to provide support for somebody who is experiencing phantom pain. Treat as if it’s real pain because to them it is very real.
- Relax: engage in activities that can help you beat the stress and reduce muscle tension. Activities that make you happy.
- Don’t be afraid to ask for help. Other people might be a valuable asset in distracting you from problems.
- Do not forget your medication
- Exercise: engage in physical activities like walking, cycling, dancing, swimming – whatever you enjoy.
- Distract yourself: yet again, engage in activities that you love and that make you happy
- Take care of the stump: follow your doctor’s instructions in order to let the stump properly heal.
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