Phantom Limb Pain and Phantom Exercises

What Is Phantom Limb Pain?

Pain in the region where an arm or leg has been amputated is known as phantom limb pain. It may begin within the first week following amputation, or it may take months or even years. It may be shooting, stabbing, cramping, pins and needles, crushing, throbbing, or searing pain.

What Are the Types of Phantom Sensation?

Amputation patients may also suffer phantom sensation, which is not the same as phantom limb pain. The phantom sensation is almost universal, and it has nothing to do with pain.

Phantom sensations can be classified into three categories:

• Kinetic sensation due to movement.

• Exteroceptive, which occurs due to touch, pressure, temperature, itch, or vibration.

• The kinesthetic sensation is based on size, shape, and position.

What Causes Phantom Limb Pain?

Phantom limb pain is considered to be generated by confusing signals from your brain or spinal cord, as opposed to pain caused by direct trauma to a limb. This is a crucial idea to keep in mind because the treatment for this type of pain differs from that for other types of pain. The goal of new therapies is to alter the impulses sent by the brain or spinal cord. You may notice that particular activities or conditions, like any other type of pain, cause it to trigger.

These are some of the possible triggers:

• Touch.

• Urination or defecation.

• Angina.

• Cigarette smoking.

• Herpes zoster.

• Variations in barometric pressure.

• Changes in the weather.

• Stress.

• Sexual intercourse.

• Infection.

• If swelling in the arm or leg is present.

• Exposure to cold.

• Being too tired.

• Decreased blood flow.

How Phantom Limb Pain Diagnosed?

There are no medical tests that can be used to identify phantom limb pain. The diagnosis is made based on your symptoms and the events that occurred prior to the onset of the pain, such as illness, trauma, or surgery prior to the amputation. Your physical therapist will assess the problem if you describe what seems to cause the phantom pain clearly and exactly. To help clarify aspects of your problem and how it is affecting your everyday life and activities, the physical therapist may have you complete questionnaires concerning your symptoms and functional challenges. All other possible causes of your pain must be eliminated. Your physical therapist will consult with your doctor to determine whether you need more tests to rule out other issues like poor circulation and may refer you for X-rays to look for bone spurs or other abnormal bone formations.

How Is Phantom Limb Pain Treated?

It takes a comprehensive approach to effectively treat phantom limb pain. Medications from a variety of categories, combined with non-medication therapy, appear to be the most helpful. This medication/non-medication approach is comparable to treating other painful illnesses.

For phantom limb pain management, you will take medications that block pain impulses in your brain or spinal cord, as well as non-medication therapies that change how your brain interprets these signals.

Medications for Phantom Limb Pain:

There are different types of drugs that might help you feel better. They are thought to work on many types of pain sensations.

Some of the medications you may be given come into the following categories:

• Acetaminophen and non-steroidal anti-inflammatory drugs.

• Opioids.

• Antidepressants.

• Anticonvulsants.

• Beta-blockers.

• Muscle relaxants.

Non-Medication Treatments for Phantom Limb Pain:

Alternative or complementary therapy can help with phantom limb pain reduction.

Here are a few of them:

• Acupuncture.

• Massage of the residual limb.

• Mirror box therapy.

• Biofeedback.

• TENS (transcutaneous electrical nerve stimulation).

• Virtual reality therapy.

• Mental imagery.

• Graded Motor Imagery.

• Anti-neuropathic medication or opioids.

• Physical exercise or limb mobility.

• Prosthetic use.

• Use of a shrinker.

• Irritant management.

• Education and awareness.

What Are the Exercises and Therapies Used to Relieve Phantom Limb Pain?

To avoid worsening symptoms or to solve the condition, phantom limb pain must be controlled. Pain treatment involves employing a variety of strategies to manage the problem's biological and complicated causes. In addition to physical therapy, a symptom-specific approach may include the use of medicine recommended by a physician, psychiatric and behavioral therapies, and, if necessary, surgical intervention may be required.

Your treatment plan may include:

Electrical Stimulation:

• TENS (transcutaneous electrical nerve stimulation).

• Electromyo Feedback.

• EMG biofeedback.

Manual Therapy:

• Massage.

• Manipulation (gentle limb movements performed by the physical therapist).

Stump Management:

• Skincare.

• Stump shrinker use.

• Stump sock use.

Prosthetic fittings and instructions on how to utilize them properly. Your physical therapist may conduct and/or refer you for proper prosthetic device fittings, as well as assist you in learning how to use your device safely.

Left/right discrimination training, explicit motor imagery exercises, and mirror therapy are three effective treatment strategies for phantom limb discomfort. These approaches are administered in sequential order, but the patient and physician must be willing to move forward, backward, and sideways in the treatment process to meet the needs of the individual.

Left/Right Discrimination:

It is the ability to distinguish between images of their painful body parts on the left and right sides. This capacity appears to be critical for normal pain healing. The best part is that, with proper training, the brain can become flexible and changeable.

Explicit Motor Imagery:

Basically, it is the act of thinking about moving without really moving. If you are in pain, imagining movements can be difficult. This is most likely due to the fact that 25% of your brain's neurons are mirror neurons, which activate when you think about moving or watch someone else move. When you imagine movements, you use the same brain areas as when you actually move. This is why athletes visualize an activity before engaging in it.

Mirror Therapy:

Mirror therapy is one of the rehabilitation treatments for phantom limb pain that has shown improvement in recent years. The use of a mirror to generate a reflecting illusion of an injured limb in order to trick the brain into thinking movement has happened without pain, or to create positive visual feedback of limb movement, is the principle of mirror therapy. A mirror box is a tool that makes it simple for the therapist to generate this illusion.

It is a box with a single mirror in the center, with hands placed on each side so that the diseased limb is always covered and the unaffected limb is kept on the other side, whose reflection may be seen in the mirror. The good limb is placed on one side, while the stump is placed on the other. The patient then makes mirror-symmetric gestures in the mirror on the side with an undamaged limb, similar to what a symphony conductor may do or what we do when we clap our hands. The phantom limb appears to be moving because the subject sees the reflected image of the good hand moving. It is feasible for the patient to move the phantom limb and unclench it from potentially uncomfortable positions by using artificial visual input.

Can Phantom Limb Pain Prevented?

There is no concrete evidence that phantom limb pain may be avoided. Pain therapy that eliminates symptoms before and after amputation may help delay or even avoid the onset of pain. However, some people will have phantom limb pain even with effective pain treatment.

Conclusion:

Phantom exercises appear to help people with phantom pain, but further study is needed to prove this. In lower and upper limb amputees, phantom limb exercises can be performed safely to relieve phantom limb pain.