You might experience phantom pain if you've lost a limb due to an amputation. Although the pain is actual, it appears to be emanating from the missing bodily component. Some individuals experience ongoing limb discomfort in the remaining portion of the limb. Phantom limb pain can be minor to severe and last for a few seconds, several hours, or even days. It might happen following a surgical amputation (removing part of a limb with surgery). It can also occur when you lose a finger, toe, or another body part due to an accidently amputated limb. Phantom pain is manageable.

Phantom sensations: The missing extremity or limb still has a sense of being a part of the body. There is little discomfort. When experiencing phantom sensations, a person could attempt to walk on both legs without realizing that a lower limb is gone.

Residual Limb Pain: Pain in the residual portion of the limb (the stump), where the limb was amputated, is referred to as residual limb pain. Medical conditions including nerve injury or entrapment are frequently to blame for persistent limb discomfort (pressure on the nerve). It affects almost 7 out of 10 people who have lost a limb.

Discovery

In the mid-1990s, the famous neuroscientist Vilyanur S Ramachandran introduced to the world the Mirror therapy, which he used for a variety of diseases and syndromes ranging from stroke to the astounding medical phenomenon phantom limb.

Dr. Ramachandran has worked with Mirror neurons and phantom limbs for above 20 years. The phantom limb is a medical syndrome that occurs in at least 90% of amputees. Around two-thirds of them experience it as an unquenchable itch in the amputated limb. Many patients also report feelings of severe discomfort and even unending pain. In most of these cases, painkillers and surgical treatment have no effect.

Researchers have hypothesized that this sort of pain in the phantom limb may be induced by a conflict between visual feedback and proprioceptive representations of the amputated limb in the cortex. This led to the hypothesis that illusions or imagery of movement of the amputated limb might aid in easing the phantom limb pain. It is this hypothesis that led to the use of mirror therapy in patients who presented phantom limb pain

Dr. Ramachandran’s first phantom limb patient Victor lost his arm while crossing the Mexican-American border and was experiencing an itch in his missing hand. When Dr. Ramachandran prodded Victor in different parts of his face with a cotton bud. When he touched the left cheek, Victor felt it in his missing left thumb and when he touched Victor’s upper lip, he felt the touch in his missing index finger.

That is, somehow the neurons that detect sensation in the missing hand had started detecting sensation in his face. In such cases, scratching the face would be an effective treatment for the phantom itch. Moreover, it demonstrated the plasticity of the cortex, i.e. the ability of neurons to adapt to each other and the environment.

The notion of plasticity was radical at the time when the popular idea was that the brain is made up of independent blocks that were separated from each other and were responsible for a specific function. In 1994, Dr. Ramachandran proved his theory by mapping the brain activity of a group of amputees. He was able to demonstrate using imaging techniques that neuron activity migrated from the hand area to the face. After this ground-breaking study, much research has been conducted that demonstrated the function of plasticity of neurons.

Involvement of Mirror Neurons in Treatments

Dr. Ramachandran searched and learned so much more that neuronal plasticity by studying phantom limbs. He followed the work of Italian scientist Giacomo Rizzolatti, who discovered an entirely new type of neuron that he called the Mirror neuron. These mirror neurons fire when a person either performs an action or observes another person acting. This further goes on to explain how the visual input of some movement of the amputated limb in the reflection might reduce the activity of systems that perceive phantom pain.

He applied this result to phantom limbs. He hypothesized that if mirror neurons fired when an individual watched someone moving a limb then visual perception might play a significant role in creating the sensation of movement. He designed and applied mirror therapy to his subjects

A study conducted by Chan et al in Walter Reed Army Medical Center, Washington in 2007 showed that mirror therapy reduced phantom limb pain in patients who had undergone amputation of lower limbs. They explained this pain relief associated with mirror therapy using ‘activation of mirror neurons in the hemisphere of the brain that is contralateral to the amputated limb’ (Chan et al, 2007).

Mirror Therapy

In mirror therapy, the amputated (phantom) limb is placed behind a mirror. When the patient looks into the mirror, she/he/they feels that the reflection of the real hand/leg is superimposed on the phantom. The patient then tries to move both hands/legs. During this, many patients feel like the phantom is imitating the real limb’s movement. When looking at the reflection, the patient feels like she/he/they can move both limbs, and the pain is relieved. By undergoing this therapy repeatedly, the phantom slowly disappears in some patients, effectively amputating the phantom limb.

The success of mirror therapy lies in the sensory conflict that is being created. Visual signals tell the brain that the phantom limb is moving. The brain might deal with the conflict by accepting the fact that there is no arm and finally, the arm disappears. Using mirror therapy, which he called Mirror Visual Feedback therapyor MVF, Dr. Ramachandran performed the first successful amputation of a phantom limb.

By 2010, mirror therapy began to be widely used in different parts with remarkable results. Most patients reported a reduction in pain over some sessions. Mirror therapy has also been used at Hedley Court, a rehabilitation center for the army of the United Kingdom for the past four years to help amputee soldiers manage phantom pain.

Much of Dr. Ramachandran’s work since developing mirror therapy has been focused on mirror neurons. He believes these neurons help us understand not only what is happening to our bodies, but also others. He calls mirror neurons the basis of empathy.

In 2009, he used the phantom limb again to show that phantom pain could also be relieved by simply watching someone else flexing or massaging their hand/leg. This simple therapy which involves no complex billion-dollar instruments has proven useful in treating several other syndromes such as osteoarthritis, Complex Regional Pain Syndrome, the medical term for unexplainable pain in different parts of the body, and even acute stroke victims.

Other Treatments for Phantom Limb Pain

Treatment for phantom limb pain focuses on easing symptoms. They include:

· Antiseizure medications

· Beta blockers

· Muscle relaxers

· Nonsteroidal anti-inflammatory drugs (NSAIDs) or prescription pain relievers

· Antidepressants

· Injections

Treatments that send electrical impulses to the nerves, brain or spinal cord may help ease the pain. These include:

· Neurostimulation

· Spinal cord stimulation

· Transcutaneous electrical nerve stimulation (TENS)

About 40% of amputees are lucky enough to afford physical therapy and get Prostheses for their lost limb. Wearing prosthetics cannot make Phantom sensations disappear. They persist even when prosthetics are worn.

Phantom limb pain is a common occurrence, in people after amputation or the loss of an extremity. No one should be ashamed to ask for help. These aching sensations are real. The stump, which is still attached to the body, may possibly have an infection or another issue that hurts. The source of discomfort can be identified, and therapies can be given by a healthcare professional. Over time, phantom limb discomfort frequently gets better.

Join MedBound - an ecosystem for students and professionals of medical and health sciences.