Phantom limb pain, or pain that feels like it is coming from a body part that is no longer there, was once thought to be a purely psychological phenomenon. Excruciating at times, the pain can be stabbing or shooting, squeezing or even burning in nature. Phantom limb pain should not be confused with phantom limb sensations that include symptoms ranging from feelings of cold or warmth to itchiness or tingling.
According to the New England Journal of Medicine, at least 90% of amputees experience phantom limb pain. While the exact cause is not clear, doctors now believe that phantom limb pain originates in the brain and spinal cord. MRIs have shown that the part of the brain that had been neurologically connected to the missing limb shows activity when the patient experiences phantom limb pain. Research into the brain’s role in pain is opening the way to new treatment approaches where there had been little or no effective treatment in the past. Chronic in nature, phantom limb pain has rarely been improved by traditional medical treatments.
However, there is new hope for patients suffering from this debilitating pain. These new treatments are based on understanding the pathways of the brain and the origin of the pain itself. Some experts believe that the pain is the result of mixed signals from the brain. Basically, the brain loses input from the missing limb and utilizes the body’s most basic way to signal something is wrong, pain. It is also possible that the brain attempts to remap that part of the central nervous system, causing pain in another part of the body rather than the missing limb area. Nerve damage, scar tissue and the memory of pain before the amputation may also play a role.
Mirror therapy is one treatment option that has been used with more and more success to alleviate phantom limb pain. Mirror therapy treats the patient by using the reflection of their intact limbs while moving the mirror and having the patient move the phantom limb in the way that they are observing the movement in the intact limb. Started in the early 1990’s by behavioral neurologist Vilayanur S. Ramachandran, and more recently through research studies by Jack Tsao, amputees were assigned to one of three groups:
1) Mirror movements: patients watched the reflected image of their intact foot in a mirror while they moved both feet simultaneously. (Obviously, amputees can’t move their missing foot, but they can move their phantom foot.)
2) Covered mirror movements: patients performed the same movements but the mirror was covered so they did not see a moving limb.
3) Imagined movements: subjects mentally pictured moving the phantom foot, with eyes closed.
All patients performed 15 minutes of their assigned therapy per day. After four weeks, there were two key findings: first, all patients doing the mirror movements had success in measured pain relief; second, half or more of the patients in the other two groups got worse, not better.
So what does that tell us? Seeing the movements in perhaps the key to the effectiveness of the treatment. The study also shows that this type of treatment has a cumulative affect with the continual mirror movements actually working to correct the faulty mapping of the brain to the missing body part connection. When the brain can use visual input of a body part to return the pathways to normal, the phantom limb pain resolves. With such complex symptoms, it is encouraging to see that many patients are finding relief with new and advancing technologies. Mind-body techniques are leading the way for patients who want a fast-acting and effective course of treatment without drugs, many of which are highly addictive, costly and on-going therapies and invasive surgical procedures.
There is still much to be learned about these procedures but the future is very positive. For more information on safe, effective and non-invasive treatment options, please peruse our website or contact us today to schedule an appointment to review your case.