Phantom Limb Pain

Phantom – an image or impression not evoked by actual stimuli, Encyclopedia & Dictionary of Medicine & Allied Health

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A part of the preoperative care of a client for amputation is that he or she must be prepared both physically and psychologically for the removal of a limb. It is important to relay the message that their life will have changes and help is available from various resources, to continue to live independently.

One of the concerns that arises and is included as part of preparing the client is to state that phantom pain can develop. Successful treatment of chronic phantom limb pain (PLP), has been found difficult. Some treatments include:

– Heat application

– biofeedback to reduce muscle tension

– Relaxation techniques

– Hypnosis

– Acupuncture

– Massage of the amputation area

--Surgery to remove scar tissue entangling a nerve

– Physical therapy (Usually, the best approach is to combine multiple treatments.)

– Transcutaneous electrical nerve stimulation (TENS) of the stump

– Neurostimulation techniques such as spinal cord stimulation or deep brain stimulation

– mental imagery

– Epidural and Intrathecal analgesia

Pain nerves are abundantly scattered throughout the body to provide warning to a person that tissues are being damaged and to seek relief. All pain receptors are free nerve endings specially designed to perform the function of receiving and relaying pain impulses.

Fighting pain requires a lot of energy and the person struggling eventually becomes fatigued and therefore likely to react more intensely to pain due to passing their threshold. Ongoing pain is a unnecessary suffering.

Damaged tissues and cells release chemicals such as histamine, potassium ions, bradykinin, acids, prostaglandins and acetylcholine which stimulate the chemosensitive pain receptors and can damage them as well. These impulses are sent up the spinal cord to the thalamus or brain stem and then onto the cerebral cortex.

A internal system of the body called the opioid system can produce morphine-like substances called enkephalins and endorphins which occur naturally when the body feels pain or pleasure. They travel down the spinal cord and block or significantly reduce the transmissions of where is pain is perceived. It has been discovered that with the addition of tactile sensory input (massage, relaxation techniques) this further reduces the pain signals being sent. The body can only send signals one or the other way but not together.

– Enkephalin, function as neruotransmitters or neuromodulators and involved with pain perception, movement, mood, behavior and neuroendocrine regulation.

– Endorphins, modulate the transmission of pain perceptions and act as analgesics.

Effects of exercise makes many changes in different body organs. Muscles will require a increased blood flow for greater energy needs and the heart and lungs will work faster and more efficiently. These changes are controlled with the release of chemicals epinephrine and norepinephrine.

– Epinephrine, hormone produced by the adrenal glands and aid the body for energetic action and most effective against anaphylactic shock.

– Norepinephrine, a catecholamine which is a neurotransmitter of certain tracts of the central nervous system and a neurohormone released in response to hypotension.

Carbon dioxide is removed with the increase of oxygen from the lungs. Mobility of joints and increased strength in muscles and tendons make them more resistant to injury. Muscle cells rise in their own chemical activity with consumption of oxygen and glucose. The heart increases blood flow to the muscles by narrowing on the skin and in the stomach to compensate for the increased requirements of the muscles.

Exercises for the amputee are started as soon as possible, if not the day after surgery, to strengthen muscles and prevent contractures (abnormal shortening of muscle). Exercises such as range of motion exercises (active or passive) are recommended to prevent constant shortening or stretching of muscles and tissue.

Research is ongoing for better treatment of PLP by pain specialists but currently can only strive to alleviate a clients level of pain. There are so many different aspects of the body that must be investigated.

I would like to take this time to introduce Hydrau1, a fellow Hubber who had sent a email request, on this topic. I recommend a moment of your time to visit his Hubs and share your ideas, comments and observations, here ---> http://hubpages.com/profile/Hydrau1

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