Imagine losing a part of your body, and still feeling its presence. For many amputees, this is a condition known as phantom pain, a distressing sensation where the brain continues to perceive pain in a limb that no longer exists. Despite the absence of the limb physically, the pain feels too real. What happens in the brain to make this possible?
Phantom pain is like a two-sided coin, where both psychological and neurological aspects. To shed light on this complex condition, MedBound Times consulted Dr. Sarthak Dave, MD Psychiatry, A Psychiatrist from Ahmedabad who generously shared his insights to help us understand the science behind phantom pain.
What is Phantom limb and Phantom limb Pain?
Phantom limb is an abnormal perception of the body brought about after an amputation of a part of the body. A phantom limb is the subjective sensation of the existence of the lost limb after amputation. According to a review, Phantom limb occurs immediately after amputation in 90%–98% of amputees.2
Phantom limb pain is the sensation of pain in the body part that is amputated (limb loss). Sensing pain in a part of your body that has been removed could seem like an illusion. However, you are in real suffering. Your body is experiencing an adjustment.1
There are different types of pain related to amputation:
Phantom pain is felt in the missing limb, while phantom sensations involve feeling that the limb is still there with sensations like touch or pressure but no pain.
Phantom pain syndrome includes both pain and other sensations in the missing limb.
Residual limb pain affects the remaining part of the limb (stump) and is often caused by issues such as infection or nerve damage.1
Dr. Sarthak shared that, similar to other types of pain, phantom limb pain can be intensified by stress and anxiety. These factors worsen the pain by increasing muscle tension and making the brain more sensitive to pain signals due to which the perception of pain may be amplified and become more persistent, the nervous system becomes more reactive and less capable of managing the pain.
Let us discuss in detail the Psychological causes of phantom limb pain.
Emotional Factors
Anxiety and Depression: Anxiety and depression are common among amputees, especially in the initial period. Depression may be related to the emotional stress because of the amputation, while anxiety is often caused by concerns about how they would transition to living without the missing limb.
Stress and Tension: PLP may also be brought about by high amounts of stress. The central nervous system is affected by stress, leading to increased perception of pain. Which is why reducing the intensity of PLP requires effective stress management.4
Psychological factors, such as distress from helplessness and fear of dependency, can intensify phantom limb pain. Defense mechanisms like denial and repression may also contribute, as unresolved emotions can heighten the brain’s misinterpretation of signals, leading to more intense pain.Dr. Sarthak Dave, MD Psychiatry, Ahmedabad
2. Cognitive Factors
Attention, Expectations, and Beliefs: The way an individual focuses on, expects, or interprets pain may affect their experience of PLP. Pain is sometimes modulated by changing attention and expectations, as demonstrated by hypnosis and placebo therapies.
Memory and Pain: PLP may be influenced by memories of pain from before amputation. Pain sensations in the limb that has been removed may persist because the brain might "remember" the pain that was experienced prior to limb loss.
Coping Mechanisms: An individual's methods for managing pain may affect PLP. Typical methods consist of diverting attention, reinterpreting pain, or seeking help. But not all coping mechanisms work, and some, like catastrophizing—imagining the worst—can exacerbate symptoms of condition (PLP). It may also affect how the brain processes pain signals, making the pain feel worse.4
3.Changes in Body Perception
Altered Body Image: The brain's picture of the body varies after an amputation. This may cause the brain to feel sensations as though the phantom limb has been retracted into the residual limb or is shorter (telescopic limb). Perception changes can have an impact on PLP.
Mental Representation and Pain: PLP may be exacerbated by difficulties imagining the missing limb moving or by changes in brain activity associated with the missing limb. In an effort to reduce pain, therapies that target these mental images are being researched.4
Knowing the factors causing or emphasizing the pain allows the development of efficient PLP management strategies.
Phantom Limb Pain Relief Options:
People can experience relief from pain and an improvement in their quality of life by treating both the psychological and cognitive aspects of PLP.
Medications:
Antidepressants
Anticonvulsants
Opioids
Other Painkillers: NMDA receptor antagonists (e.g., dextromethorphan, ketamine), over-the-counter options (e.g., aspirin, acetaminophen), local pain-blocking injections.3
Recent advancements in treating Phantom Limb Syndrome (PLS) include virtual reality (VR) therapy, mirror therapy, and brain-machine interfaces.Dr. Sarthak Dave, MD Psychiatry, Ahmedabad
Non-Drug Therapies:
VR therapy: Dr. Sarthak explained that VR therapy allows patients to visualize and control a virtual limb, which can help reduce pain and discomfort. Brain-machine interfaces target neural pathways to rewire the brain’s perception of the missing limb.
He added that these treatments address the maladaptive brain plasticity associated with Phantom Limb Syndrome (PLS), reducing the brain’s erroneous signals that cause phantom pain.
Nerve Stimulation: TENS (transcutaneous electrical nerve stimulation) devices.
Mirror Box Therapy: Uses a mirror to create the illusion of an intact limb during exercises.
Acupuncture: Thin needles inserted into specific skin points to release pain-relieving chemicals.3
Cognitive-behavioral therapy (CBT) :
Dr. Sarthak highlighted that Cognitive-Behavioral Therapy (CBT) is particularly effective in helping patients address the emotional impacts of the syndrome, such as anxiety and depression. It assists in modifying maladaptive thoughts and behaviors related to pain and phantom sensations, contributing to a comprehensive, personalized treatment approach.
Lifestyle Tips:
Find distractions from pain
Stay physically active
Practice relaxation techniques (e.g., meditation, visualization)3
Effective strategies for Phantom Limb Syndrome include mirror therapy, virtual reality therapy, medications, brain stimulation, and cognitive-behavioral therapy (CBT). These methods aim to alleviate pain, rewire brain perception, and address the stress and anxiety associated with the condition.Dr. Sarthak Dave, MD Psychiatry, Ahmedabad
Phantom limb pain is an intriguing phenomenon that illustrates the intricate manner in which our brains process and perceive pain, even in the absence of physical limbs. It is essential to comprehend the neurological and psychosocial components of this illness in order to create therapies that work. There are several ways to get relief, ranging from innovative therapies like virtual reality and mirror therapy to psychological approaches like cognitive-behavioral therapy. As research progresses, these discoveries offer hope for a better quality of life for people experiencing phantom limb pain by ensuring that their discomfort will not be overlooked or left unattended.
https://my.clevelandclinic.org/health/diseases/12092-phantom-limb-pain (cited on 22/08/2024)
https://www.sciencedirect.com/topics/neuroscience/phantom-limb#:~:text=There%20are%20several%20hypotheses%20for,sudden%20and%20drastic%20body%20change.(cited on 21/08/2024)
https://www.webmd.com/pain-management/phantom-limb-pain(cited on 23/08/2024)
https://onlinelibrary.wiley.com/doi/10.1155/2018/5080123(cited on 22/08/2024)
MSM