PHANTOM PAIN -- Overview

This essay, written by Delano P. Wegener, Ph.D. in June 2015, is an overview of some aspects of phantom pain. Although the topics of phantom sensations and stump pain are important, they will not be discussed in this essay. A special thank you goes to Sharon Senetar for her excellent proofreading and editing which put the finishing touches to this piece.

The first recorded description of phantom pain was written by a French military surgeon in about 1550. In 1871 a man named Mitchell coined the name "phantom pain" and it has been used consistently since 1871.

A large number of treatments have been proposed. Studies to detemine the effectiveness of these many treatments have been few, small, and with no control groups; therefore most of the treatments fall into the category of urban legend rather than established fact. The "evidence" to support many of these so-called treatments are anecdotal and have very little scientific standing. The right column contains a long list of proposed treatments. Some of the more scientific, and more recent studies are discussed later in this essay.

As late as 1983 many doctors maintained that anyone complaining of phantom pains was mentally disturbed. Think back 50 - 100 years: The stigma of being an amputee, although bad enough, was not nearly as damaging as the stigma associated with being mentally disturbed. As a result, amputees seldom admitted to having phantom pains. Early studies of the incidence of phantom pain concluded that only about 2% of amputees experienced phantom pains. More recent studies show that nearly all amputees experience phantom pains sometime. Many amputees experience phantom pain within a few days of the amputation. But for others the onset of phantom pains is weeks, months, years, and even decades after the amputation. Frequency, duration, and intensity are all over the board.

There is no established link between the person's health (before or after) and incidence of phantom pain. Some amputees who had extreme pain in the amputated limb prior to the amputation reported the same pain, manefested as a phantom pain after the amputation. There have been some recent small studies to test this hypothesis. In these studies the pain was removed (sometimes with an epidural injection) for a period of weeks prior to the amputation The conclusion at this point in time is that it is unlikely that any preemptive treatment will prevent phantom pain.

Mechanism of Phantom Pain

It is helpful to introduce this section of the overview with a quote from Professor Marshall Devor of Hebrew University. "Phantom limbs have long been a mystery. Early theories saw them as proof of the immortal soul or part of the Freudian mourning process for the amputated limb. Nowadays, the standard explanation is that the ghostly appendages - which lurk painfully in place of amputated ones - result from confusion in the brain's map of the body ".

The brain's map of the body referred to by Devor is in the cortex, in particular the part involved with phantom pain is in the sensorimotor area of the cortex.

Every part of our bodies are saturated with specialized sensory receptors (nerve endings) responsible for detection of unpleasant stimuli. When one of these receptors detects an unpleasant stimulus it generates an electrical signal which is then conducted to the central nervous system and ultimately to the spot in the sensorimotor area of the cortex which contains the map of the area where the unpleasant stimulus was detected. That area of the brain generates the appropriate sensation (heat, cold, pressure, cut, pain, etc.).

At this point the theory gets a bit tricky. I will try to explain with an oversimplified example. There is a spot in the sensorimotor area of the cortex which is responsible for all signals from sensory receptors in your big toe on your right foot. This is called the brain map of your right big toe. Now suppose your right toe is amputated. The brain map still exists but the sensory receptors in the right big toe no longer exist. The brain map no longer recieves signals and it has nothing to do. Some researchers believe the big toe map "grabs" copies of signals on their way to another brain map area -- maybe the lips. Other researchers believe the brain map of the lips notices that the brain map for the big toe is idle and deliberately tries to "take over" the big toe brain map by sending some of its signals over there. Regardless of how the signal gets to the wrong place it is not processed properly. For example suppose the brain map for your big toe gets a signal of you licking your lips. Unless you have previously engaged in some kind of weird fetish the big toe brain map will be completely confused. In an attempt to protect the big toe generates the sensation of pain, -- in the non-existent big toe. That is phantom pain.

The scientists call this whole mechanism Maladaptive Plasticity. For the sake of brevity I will use that term later in this essay.

Triggers

What triggers a phantom pain? What causes the brain map to get confused some time and not other times? Whatever the answer is, it is now called a trigger. I have found no definitive research on this topic, but there are a number of supposed triggers supported solely by anecdotal evidence.

From the Amputee Coalition Web site we learn the following. As with any other kind of pain, you may find that certain activities or conditions will trigger phantom pain. Some of these triggers might include:

  • Touch
  • Urination or defecation
  • Sexual intercourse
  • Angina
  • Cigarette smoking
  • Changes in barometric pressure
  • Herpes zoster
  • Exposure to cold.
  • Stress

Volume 15 Issue 6 September/October 2005 of inMotion magazine (publication of Amputee Coalition) http://www.amputee-coalition.org/inmotion/sep_oct_05/phantomweather.html contains the following information which I found interesting.
The association of phantom limb pain with the weather has been noted as far back as the Civil War, according to information found on The Weather Channel Web site.
From Wikipedia we learn "The first publication of documented changes in pain perception associated with the weather was in the American Journal of Medical Sciences in 1887. This case report described a person with phantom limb pain who concluded that "approaching storms, dropping barometric pressure and rain were associated with increased pain complaint."

Remedies

As with triggers, there is a plethora of remedies backed up by subjective evidence. Some remedies have been subjected to rigorous scientific studies. The right-hand column contains a long list of remedies and this column contains a discussion of three remedies. Mirror therapy, because scientific studies and its match with the Maladaptive Plasticity theory make it one of the more promising remedies. Farabloc, because it maintains a large number of advocates even in the face of scientific evidence indicating it has no effect on phantom pain. This just might be due to the complicated nature of phantom pain and may point to the need for individualized and personalized treatment plans required to provide relief from phantom pain. The third remedy in this column is a report of very current research. The technique has not yet been given a name. That discussion appears under the heading "Promising Research" and concludes this column.

Mirror Therapy:
In my humble non-medical opinion, the large number of apparent successes with mirror therapy is consistent with the Maladaptive Plasticity theory. But then there is also the mirror neuron theory which also makes sense.

The fundamental premise seems to be that the patient receives artificial visual feedback that the "resurrected" limb is now moving when they move the good hand. This fundamental concept will come into play again when I discuss Promising Research.

Mirror Therapy was invented by the neuroscientist Vilayanur Subramanian Ramachandran (born 1951).

As best as I can determine this first mirror box was built in 1996. It is surprising that the research is not yet very clear on the effectiveness of mirror therapy.

In the article "Mirror Therapy for Phantom Limb Pain" by Sae Young Kim, MD, and Yun Young Kim, MD, "The treatment for phantom limb pain includes medication, physical treatment, nerve block, neuromodulation, and surgical treatment. Nevertheless, any effects of these methods have not yet been proven." Even in the face of many individual claims about the marvels of one treatment or the other, none has been proven to be uniformly effective for all patients for all kinds of phantom pains.

A review (Published 2011) of scholarly research articles revealed that the quality of evidence of the effectiveness of mirror yherapy was low and that little is known about which patients benefit most from mirror therapy nor how that therapy should be applied. These conclusions were essentially the same as reported in a similar literature review completed in 2009. The 2009 review indicated a trend toward effectiveness in upper limb phantom pain with no evidence of effectiveness in other patients. Links to abstracts of these reviews are in the right hand column.

In a small but well constructed experiment at Walter Reed, Brenda L. Chan et.al. reports the following.
"Our findings showed that mirror therapy reduced phantom limb pain in patients who had undergone amputation of lower limbs."
They suggest that "mirror therapy may be due to the activation of mirror neurons in the hemisphere of the brain that is contralateral to the amputated limb".
They conclude their report with,
"Although the underlying mechanism accounting for the success of this therapy remains to be elucidated, these results suggest that mirror therapy may be helpful in alleviating phantom pain in an amputated lower limb."


Illustration of Mirror Therapy with Lower Limb

Click photo for screen-resolution image
Navy Cmdr. (Dr.) Jack Tsao, associate professor of neurology at the Uniformed Services University of the Health Sciences, in Bethesda, Md., encouraged Army Sgt. Nicholas Paupore, an outpatient at Walter Reed Army Medical Center, in Washington, D.C., to try mirror therapy to treat phantom pain in his amputated right leg. Tsao conducted the first clinical trials in mirror therapy and said he hopes to advance the study to bring relief to amputees from Iraq and Afghanistan. Photo by Donna Miles
  

(Click photo for screen-resolution image);high-resolution image available.
The sergeant certainly looks dubious!


Illustration of Mirror Therapy with Upper Limb

Evidently, enough people believe that mirror therapy works to warrant a commericial version for home use. The pictured mirror box is available at Amazon.

Farabloc:
In 1969 Frieder Kempe, president of the Farabloc Development Corporation, Coquitlam, British Columbia, Canada, began a quest to find a solution to combat the phantom pain of his father, Rudolf Kempe, a World War II veteran and amputee. The result of Frieder's work is a patented, lightweight cloth designed to shield the wearer from electromagnetic fields (EMF) in the high-frequency range that can cause damage at the cellular level. Farabloc Development Corporation was formed in 1983. Farabloc consists of a series of ultra-thin steel fibers woven into a nylon fabric, which is custom made into wraps or garments, such as socks, gloves, jackets, blankets, and limb covers for amputated areas.

I have reviewed dozens of papers and believe that there are numerous credible personal testimonials to the effectiveness of Farabloc in treatment of phantom pains. Solid research does not confirm the personal testimonials. However, one must remember that no two people experience the same type or intensity of pain, so there isn't a "pill" that works for all.

Promising Research

The article "Suffering Phantom Limb Pain?" in vol.24, issue 5 September/October 2014 of inMotion ( LINK) by Amy Di Leo is excellent. It contains a good introduction to phantom pain, ideas of causes, triggers, and treatments. The last half of the article is a discussion of some of the current research into the very basic scientific principles involved with phantom pain.

The four cited researchers (Tsao, Pasquina, Wegener, Cohen) are each affiliated with some branch of the U.S. Military. It is not surprising that the military has a keen interest in phantom pain, but it would have been nice to include a discussion of research being conducted in civilian institutions.

In the last year or two there have been three independent experiments which have produced similar very encouraging results.

The three experiments were conducted by researchers in Israel, Germany, and Ohio and each was based on the same novel reaction to the theory of Maladaptive Plasticity. In very simplistic terms this is the approach: If the phantom pain in a hand or foot is caused by its brain map receiving no signals then let's build a prosthesis which will send signals to that brain map. In every case the idea worked.

The three principals in this exciting new research direction are:

  • Thomas Weiss, PhD, Friedrich-Schiller-University, Jena, Germany
  • Dustin Tyler, biomedical engineer, Case Western Reserve, Cleveland, Ohio
  • Professor Hubert Egger, University of Linz, Austria,

For each of these three researchers the initial goal was to produce a prosthesis which would be capable of "feeling". If a prosthesis can provide some "feeling" feedback then it will function better. Restoration of feeling in a prosthetic hand for example, will allow the user to exert different pressures when picking up a grape as opposed to a pencil. Patients with prosthetic legs and feet which provide sensory feedback are able to walk on snow or ice without slipping and can feel the kind of material (concrete, gravel, grass, etc.) they are walking on.

In each case the basic idea is simple, but implementation options may be difficult. They build five or six sensors into the foot/hand of the prosthesis and then connect these sensors to the nerve endings in the residual limb. Any sensation captured by the sensors is transmitted though normal channels to the brain map for the amputated foot/hand. Because the brain map has no idea (nor cares) how the sensations are generated it reacts as it did prior to the amputation. As predicted, in each experiment the limb became more functional and provided the user with an experience a little closer to normal.

An unexpected side effect was reported by each patient almost immediately. Their phantom pains disappeared.

In a nutshell the standard explantion is: The amputated limb exists in the brain and when it starts receiving signals from the feeling prosthesis, it stops its frantic search which was producing the phantom pains.

These devices have been in testing for only a few years and with limited number of patients. Therefore we are several (5 -10) years from seeing them on the market.

Challenges to the Conventional

In Science it is important that theories be challenged. So it is a good and expected thing that the Maladaptive Plasticity theory should get challenged. I have found two such challenges.

Tamar Makin from Oxford University, UK, and colleagues challenge that orthodoxy in a paper published March 5, 2013 in Nature Communications. They find that amputees who experience ample phantom pain have stronger rather than weaker cortical representations of the missing body part, and no evidence of remapping. However, when I read about Makin's research I do not come to the same conclusions he does. Professor Scott Frey (Univ. of MO., Columbia) does not subscribe to the Maladaptive Plasticity theory but he questions the conclusions drawn by Makin. Such is the nature of brain research.

The second paper to challenge is by professor Marshall Devor of the Hebrew University. Professor Devor makes some very bold statements. I have not reviewed his research report. Check out the link in the right hand column.

PHANTOM PAIN -- Internet References

Mayo Clinic
Phantom pain is pain that feels like it's coming from a body part that's no longer there. Doctors once believed this post-amputation phenomenon was a psychological problem, but experts now recognize that these real sensations originate in the spinal cord and brain.

Mayo Clinic
Treatments and Drugs.
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 or transcutaneous electrical nerve stimulation (TENS).

Capturing the Phantom by Christina DiMartino
An excellent overview of phantom pain. The article cites work by medical professionals dealing with large samples of amputees. The article is a little weak with respect to treatments and is not complete in its report of Farabloc. There is no mention of mirror therapy nor is there any indication of treatments to come. I highly recommend reading this paper but be aware of its limitations including its age - it was written in 2000.

A Good Overview
From the British Journal of Anaesthesia in 2001. Great list of 91 references. Because of its date it cannot include work done in the last ten 13 years.

Larson's List of Treatments
Allan Larson, a below-elbow amputee who is affiliated with the Saskatoon Amputee Support Group, Inc. in Saskatchewan, Canada, has assembled this excellent list of these therapies. This list was compiled in 2002 so some new treatment can be added. See my overview to read about some new promising treatment possibilities.

Collection of Essays -- The War Amps -- Canada
This is an 88 page PDF containing 26 different essays.

OnLine Journal of Continuing Education in Anaesthesia - Oxford University
The article is pretty technical because it is written for doctors.

Mount Sinai Hospital
A brief article explaining what phantom pain is, its diagnoses, treatment, etc.

The Journal of Family Medicine
Stresses management of phantom pain.

Pretty Good Essay on Phantom Pain
Seems to be comprehensive and carefully researched.

Mirror Therapy for Phantom Limb Pain
Discusses the apparent benefits, especially for deep pain vs surface pain, of mirror therapy and tries to explain why it might work. An intelligent discussion but not very convincing. These authors are adamant in the claim that no treatment has been proven to be successful.

2011 Lit. Review for Mirror Therapy No definitive conclusions can be drawn.

2009 Lit. Review for Mirror Therapy Much of the research is poorly constructed and no conclusions can be drawn.

Cutting Edge Research

Suffering Phantom Limb Pain?
The last half of the article is a discussion of some of the current research into the very basic scientific principles involved with phantom pain.

Weiss in Jena Germany -- Arm with Sensations Stops Phantom Pain
An arm with sensors -- makes use of the idea of maladaptive cortical reorganization. He makes use of the most common theory of how the brain reacts when a limb is amputated.

Work at Case Western Reserve on Feeling Arms
"It's not the first prosthetic to restore touch to an amputee, but it may provide a more "natural" sensation than earlier devices, ...", said head researcher Dustin Tyler, a biomedical engineer at Case Western Reserve in Cleveland, Ohio.

Egger's Feeling Prosthetic Leg at Linz University in Austria
This is a good description in layman's terms that gives more insight into the Maladaptive Plasticity Theory upon which Egger's leg is based.

Another Article about Egger's Prosthetic Leg
Researchers in Vienna have pioneered the first artificial leg capable of transmitting feelings to the brain like a real limb. It also stops phantom pain, a condition that many amputees suffer from.

Oxford Challenge to Maladaptive Plasticity Theory
Tamar Makin, a neuroscientist at Oxford University, lead a study which challenges the standard Maladaptive Plasticity Theory. I could find only two studies which are in opposition to the Maladaptive Plasticity Theory.

Discussion of the Challenge to Maladaptive Plasticity Theory
This is another report of the study performed by Tamar Makin from Oxford University, UK. This report contains information and descripts not found in the report above.

A Second Challenge to Maladaptive Plasticity Theory
This is a report of a study done by Marshall Devor of Hebrew University in which they claim to have refuted the Maladaptive Plasticity Theory

Remedies

Allan Larson, a below-elbow amputee who is affiliated with the Saskatoon Amputee Support Group, Inc. in Saskatchewan, Canada, has assembled the following excellent list of phantom pain therapies. This list was puplished in Communicator - Volume 3 No. 1 - February 2002 ( A publication of The Amputee Coalition).

  1. Acupuncture
    Acupuncture is a healing art that has been practiced in China for several thousand years to treat a variety of ailments, including chronic pain. Acupuncture involves the insertion of tiny needles into the skin at specific sites. The needle is then twirled for a few minutes or a low electrical current is applied. It is not fully understood how acupuncture works - the Chinese healing art stresses the energy flow of the Ch'i, or life force, while western medicine suggests it stimulates the production of the body's natural painkillers called endorphins.

  2. Anesthetics: Preoperative: Epidural Blockade
    When amputation surgery is performed, whether caused by trauma or disease, the amputee is often in pain before the surgery commences. It is thought that this pain imprints on the brain and creates a "pain path" which then causes phantom limb pain after the limb is removed. By using an epidural, an injection of anesthetic to the spine, usually for a period of 72 hours prior to the surgery, the message of pain is blocked from reaching the brain and creating a "pain path." It has been reported that people who have an epidural blockade prior to surgery experience less pain during the postoperative period, as well as a reduction in the frequency and severity of phantom limb pain. It is also thought that the epidural reduces pain by cutting off the pain messages associated with the surgery, which still register in the brain even though the patient is unconscious.

  3. Postoperative: Local Anesthetic
    (examples: Lidocaine, Marcaine, Novocaine, Pontocaine, Xylocaine) These medications act on nerve cells by making them incapable of transmitting pain messages for a short period of time. They may be given as spinal (a small needle into the spinal column, in the lower back), epidural (a small needle and catheter into the spinal column, in the lower or mid-back), by local injection or a wide variety of nerve blocks. These may be used to relieve trigger points and reduce stump pain.

  4. Biofeedback
    Advocates of biofeedback feel that phantom pain may happen because of anxiety, which may increase muscle tension and contribute to the pain cycle. "Hyperactive muscles" cause irritation in the cut ends of the nerves in the residual limb. Electrodes are attached to the residual limb which detect when the muscle is tensed and trigger a flashing light or buzzer to provide feedback. Once the amputee has become aware of the muscle tension they learn to relax the muscle. When an appropriate decrease in muscle tension is reached the feedback stops. The focus of this treatment is to teach the muscle(s) how to relax, thereby relieving the pain.

  5. Chiropractic
    Some amputees may find relief through chiropractic - which means "treatment by hand. "Chiropractic does not involve drugs or surgery, but instead concentrates on the spine in relation to the total body. Doctors of chiropractic, or chiropractors, specialize in the understanding and treatment of the different parts of the spine: bone (vertebrae), muscles and nerves. When a vertebral joint is not working properly it can create an imbalance which disturbs the nervous system. This can lead to excess strain being placed on other joints, resulting in some form of pain. Through manual adjustment, or manipulation of the spine, chiropractic works to correct misalignments of the spine thus alleviating pain.

  6. Cold
    Applying cold to the residual limb may help alleviate some of the discomfort associated with phantom limb pain or muscle spasms. Refreshing coolness can be administered through cold compresses, ice packs or cool baths. Amputees may also wish to try a cooling cream or gel. One newer product available is Biofreeze, which is an analgesic cryotherapy gel made from the extract of a South American holly shrub. Biofreeze creates a cooling sensation within the skin that can last several hours. The same company that makes Biofreeze also makes Perform, a greaseles pain relieving spray for the neck, legs, and feet. Another gel, Glenalgesic Blue, is a topical pain fighter for the prompt and temporary relief of muscular aches and pains, containing menthol, alcohol and camphor. [See also Heat.]

  7. Cranial Sacral Therapy
    This type of therapy, involving the study of bone and joint misalignment related to the head, has been practiced by many different cultures for thousands of years. Therapeutic touch is applied to the head, and meditation and visualization techniques may also be used in conjunction with cranial sacral therapy. A therapist treating phantom pain may "massage" the missing limb, as well as encourage visualization of the lost limb in an effort to help amputees release any sense of grief, loss or anger towards the missing limb(s).

  8. Desensitization
    The nerves in the stump of the amputated limb can be very sensitive, especially directly following the amputation. Not only does desensitization reduce nerve sensitivity, it can also reduce pain and discomfort overall. Rubbing the stump with a piece of terry cloth, gently manipulating the stump manually, tapping the stump, or using a vibrator can all help to desensitize the nerves, alleviating sensation and pain. [See also Massage.]

  9. Dietary and Herbal Supplements
    Some amputees have found certain dietary supplements or homeopathic food products help reduce phantom limb pain. Examples of dietary supplements amputees have tried include: potassium;calcium; magnesium, and injections of Vitamin B12. Certain herbal products have also been found useful by some amputees including juniper berries (interestingly called "ghost-berry" by Native Americans). Antioxidants such as Pycnogenol (a pine bark extract sold in Canada as a food product) and Grape Seed Extract are extremely concentrated bioflavonoids, which until 1936 were known as Vitamin P. Antioxidants attack free radicals, which are unstable atoms inside our bodies that attack all body tissues, degrade collagen and reprogram DNA. Free radicals are believed to be the underlying cause in many diseases. Antioxidants are found in high concentrations in grape seeds and pine bark, and in lesser amounts in grape skins, cranberries, lemon-tree bark and hazelnut tree leaves. Antioxidants are available in liquid and pill form. *Amputees should always consult their doctor before taking any supplements or herbs, as these are not harmless, but can have powerful side effects. They may also interfere or conflict with other medications being taken at the same time.

  10. Electrical Stimulation
    Another theory behind phantom limb pain suggests that it occurs because the nerves in the residual limb lack the stimulus once provided by the missing limb. One electrical treatment, transcutaneous electrical nerve stimulation (TENS), uses low current at a low-frequency oscillation to stimulate the nerves and provide pain relief. The amputee feels a gentle tingling without increased muscle tension. Depending on the severity of pain, the small-battery operated device can be used for 20 minutes to a few hours of stimulation, several times daily, and the amputee can be taught how and when to apply treatment. Because TENS can cause arrhythmia, it should not be used by people with advanced heart disease or a pacemaker. Your doctor will advise if this is suitable for you.

  11. Exercise
    Exercise increases circulation and stimulates the production of endorphins (chemicals naturally produced in the brain that kill pain). Many amputees find that moderate and frequent exercise can help to reduce phantom pain. Flexing and relaxing the muscles on the residual limb also helps some amputees.

  12. Farabloc
    Farabloc is a fabric which contains extremely thin steel threads but looks and feels like linen. The makers state that Farabloc has a shielding effect from ions and magnetic influences, which protects damaged nerve endings. It stimulates blood circulation and produces a pleasant feeling of warmth. It can be cut and sewn, washed and ironed like any other fabric, and is available in blanket forms of various sizes. People may have socks, sheaths, or custom residual limb covers made from Farabloc or the material may be incorporated directly into a prosthetic socket.

  13. Heat
    Applying soothing warmth has been reported to help deal with occasional bouts of phantom limb pain. Warm baths, a heating pack, a Magic Bag (http://magicbag.com), or wrapping the stump in warm, soft fabric to increase circulation are all examples of how heat can be used. There are also rubs and gels which generate heat, such as Rub A535 or Tiger Balm. More advanced forms of heat therapy can be used under the guidance of a trained professional. Some amputees alternate between applying heat and cold. [See also Cold.]

  14. Keeping a Journal
    Some amputees write down dates and times as well as other factors that may be present when they experience phantom limb pain, such as stress. A record kept over time may indicate factors that influence or trigger the occurrence, frequency or severity of an attack of phantom limb pain in the same way that migraine sufferers have found that certain foods trigger their migraines.

  15. Magnetic Therapy
    Magnets have been used for thousands of years to treat many conditions, including recently phantom limb pain. Magnetic therapy involves applying a magnetic field to the body to relieve pain and speed up the healing process. The application of electromagnetic fields have been shown to affect cell permeability and improve oxygen delivery to the cells, which can lead to better absorption of nutrients, improved circulation, and clearance of waste products. Magnets may also reduce inflammation and pain, and promote healing. The magnets are usually incorporated into bracelets, belts, or fabric straps, and are available in differing strengths and sizes. These products are available from several companies such as Nikken and Bioflow. (It is recommended that you consult your doctor before trying magnetic therapy to ensure it is a good choice for you.)

  16. Massage
    Massaging your limb is a good way to increase blood-flow and circulation, which may help to alleviate some discomfort. Massage may also help to reduce swelling and loosen stiff muscles, which can provide some relief from pain.

  17. Medications
    Medications are useful in the treatment of pain (especially chronic pain). However, many amputees prefer to try other avenues of relief first. It is important for the amputee to understand all the possible side effects of over-the-counter and prescription medications, including the implications of long-term use.
    • Anti-Inflammatory Drugs
      (examples: acetaminophen [Tylenol], aspirin, ibuprofen [Advil, Motrin] Acetaminophen, aspirin and ibuprofen are all examples of medication which can reduce mild swelling or soreness, and are useful for mild to moderate pain. They are non-addictive and maybe effective for occasional bouts of phantom pain. One amputee uses Tylenol Arthritis Pain for relief from his phantom limb pain.

    • Anti-Depressants
      (examples: Amitriptyline, Elavil, Pamelor, Paxil, Prozac, Zoloft) Developed to treat depression, many antidepressants have been found to be useful in the treatment of many chronic pain conditions, including phantom limb pain. These drugs work centrally on the brain to either block or increase certain chemicals that help regulate normal brain function.

    • Anti-Convulsants
      or Anti-Seizure Medications (examples: Tegratol, Neurontin) These drugs have also been found useful in the treatment of phantom limb pain. They act directly on the nerves both in the residual limb and in the brain to alter neurotransmission, thus calming nerves in the residual limb which may have become over-active following amputation. These drugs are prescribed in small doses and are gradually increased to a level which promotes relief. It is also very important to decrease the dose gradually before ceasing to take the medication.

    • Narcotics
      (examples: Codeine, Demerol, Morphine, Percodan, Percocet) These drugs mimic the pain killing chemicals released by the brain in response to pain. While they are very effective as temporary solutions for pain after surgery, trauma, or to treat cancer pain, they are highly addictive and in the majority of cases should not be used for a prolonged period. Amputees who have only an occasional severe attack of phantom pain may benefit from a limited course of this type of drug. When these drugs are taken on a regular basis the patient becomes addicted and desensitized to the drugs, requiring more of the drugs while achieving less effective pain relief.

  18. Meditation
    Both physical and mental tension can make pain worse. Meditation may help to reduce phantom limb pain by relaxing tense muscles and lowering anxiety levels. The aim of meditation is to produce a state of relaxed but alert awareness, this is sometimes combined with visualization exercises that encourage people to think of pain as something remote and separate from themselves.

  19. Psychotherapy
    Some amputees may find individual or group therapy beneficial. Some have even tried hypnosis. Trained professionals can help amputees learn coping skills and can provide psychological and emotional support for dealing with pain.

  20. Shrinker Socks
    Bandaging and shrinker socks apply even pressure to the residual limb which may help to reduce or alleviate phantom limb pain.

  21. Wearing Your Artificial Limb
    As well as improving circulation, putting on your artificial limb and moving around may also help alleviate phantom limb pain.