302: Phantom Pains

Ian. Rupert. Now, Fergus.

All may now find themselves suffering from phantom pains.

“My leg, it’s not there as anyone can plainly see.  And yet, it pains me terrible sometimes.  Even wakes me up at night.” – Ian Murray

Phantom Limb Pain:  a phenomenon characterized by the experience of pain, discomfort, or other sensation in the area of a missing limb or other body part.

In fact, one does not have to lose a limb to suffer from Phantom Limb Pain.  It also can occur with the loss of other body parts: eyes, tongue, nose, even breast.

The concept of phantom limb pain is not new.  First described by the 16th Century French Military Surgeon Ambrose Pare, the term was first coined during the American Civil War by surgeon Silas Weir Mitchell.  Up to 80% of patients who undergo amputation experience phantom limb pain with a range of symptoms including burning, shooting pain, “pins and needles,” twisting, crushing, electric shock feelings, itching, and vibration.

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Why does Phantom Limb Pain occur?

In brief?  The medical community don’t know exactly.  There are a number of working theories.

One mechanism thought to be responsible for these symptoms is due to the direct trauma of the nerves themselves during amputation. The severed nerves grow and form groups of nerve cells called neuromas which then generate impulses that travel back to the central nervous system and are interpreted as pain.

Another theory suggests that the part of the brain cortex that normally receives input from that body area finds itself no longer receiving input.  The cortex reorganizes and neighboring areas take over that part of the cortex.  Because of this, pain impulses from areas of the body near the amputated limb are now interpreted as pain in the missing limb itself.

Or perhaps the symptoms are due to the lack of input.  Deprivation of the normal perception of that limb causes abnormal signals to be transmitted which are interpreted as pain.

Whatever the exact mechanism (and there are likely more than one coming into play), unfortunately phantom limb pain remains a problem difficult to treat.

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Treatment of Phantom Limb Pain

When possible, controlling pain prior to amputation can help.  Phantom limb pain occurs more frequently in those who had significant pain in that area prior to amputation.

Medications including acetaminophen, NSAIDs, opioid medications (these are thought to diminish the cortical reorganization which is one of the potential mechanisms PLP develops), antidepressants, and anticonvulsants.

TENS (Transcutaneous Electrical Nerve Stimulation) has been found to be helpful for some.

Mirror Therapy is an interesting adjunct in treatment.  Some theorize that the symptoms of Phantom Limb Pain are in part due to the absence of visual feedback about the limb to the brain.  When a patient watches the reflection of their intact limb moving, the brain interprets it as the phantom limb moving, resolving the mismatch between the visual and sensory inputs about the limb.

Fortunately, the prevalence of phantom limb pain tends to decrease over time following the amputation.

What about broken hearts?

“Feeling a pain in a part of ye that’s lost. And thats just a hand. Claire was yer heart.” – Ian Murray

The pain of love lost.  So similar.  Jamie and Claire both feeling less than whole, the pain still raw, and a constant reminder of what they have lost.

If only there was an effective treatment for that…

 

All images property of STARZ

 

 

 

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