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Phantom Pain

Condition: Phantom pain is the perception of pain in an organ or limb that is not physically present.

Background: Phantom pain occurs exclusively after limb amputation or after removal of organs, such as breast, eye, penis, or tongue. Approximately 60-80% of patients experience phantom pain within the first week after amputation, and this pain diminishes over time. Originally, phantom pain was thought to be psychological, but now doctors know that this pain originates from the spine and brain.

Risk Factors: Phantom pain is more common when pain was present in the missing limb before amputation. There is a greater incidence in patients with shorter stumps, lower leg amputations, and amputation of both legs. Children and those missing limbs at birth experience phantom pain less frequently.

History and Symptoms: Phantom pain generally occurs in the more distant parts of the missing limb, including the wrist, fingers, ankles, feet, or toes. The pain is described as intermittent burning, stabbing, prickling, or shooting. The reasons for amputation and the amount of pre-operative and post-operative pain should be considered.

Physical Exam: The physical exam will focus on the range of motion and measurements of the residual limb. Sensation, movement, and blood flow should also be assessed in the extremities on both sides of the body. If a prosthetic limb is used, the physical exam will evaluate this as well. Other potential sources of pain, including wounds, neuromas, or nerve problems, will be examined.

Diagnostic Process: Blood samples can be analyzed for signs of infection. X-rays of the limb are useful to evaluate the bony elements in the extremity. Tests of blood flow and nerve function in the remaining limb may be conducted.

Rehab Management: Physical therapy is an important part of phantom pain management along with proper stump care and prosthetic limb fit. Antidepressants, anticonvulsants, opioids, and other pain medications can be used. Massage, active and passive movement, acupuncture and transcutaneous electrical nerve stimulation (TENS) may be helpful. Other parts of treatment may include mirror box imagery treatment, stump liners, desensitization, biofeedback, coping strategies, and skin care. Psychological support may also be necessary.

Other Resources for Patients and Families: Patients and families should receive counsel on the nature and course of the pain. Education about stump and prosthesis care, relaxation, and coping skills is important.

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