Treatment of Phantom Limb Pain
Successful treatment of phantom limb pain is difficult. Treatment is usually determined based on the person's level of pain, and multiple treatments may be combined.
Some treatments include:
• Heat application
• Biofeedback to reduce muscle tension
• Relaxation techniques
• Massage of the amputation area
• Surgery to remove scar tissue entangling a nerve
• Physical therapy
• TENS (transcutaneous electrical nerve stimulation) of the stump.
In a procedure called transcutaneous electrical nerve stimulation (TENS), a device sends a weak electrical current via adhesive patches on the skin near the area of pain. This may interrupt or mask pain signals, preventing them from reaching your brain. Used properly, TENS is safe. To avoid an unintentional shock, don't wear a TENS device in the shower or tub or turn it up too high.
• Neurostimulation techniques such as spinal cord stimulation or deep brain stimulation
Electric artificial limb.
A type of artificial limb called a myoelectric prosthesis has motors controlled by electrical signals that occur during voluntary muscle activation in the remaining limb. Using a myoelectric prosthesis may reduce phantom pain.
Acupuncture. The National Institutes of Health has found that acupuncture can be an effective treatment for some types of chronic pain. In acupuncture, the practitioner inserts extremely fine, sterilized stainless steel needles into the skin at specific points on the body. It's thought that acupuncture stimulates your central nervous system to release the body's natural pain-relieving endorphins. Acupuncture is generally considered safe when performed correctly.
Mirror box. This device contains mirrors that make it look like an amputated limb exists. The mirror box has two openings — one for the intact limb and one for the stump. The person then performs symmetrical exercises, while watching the intact limb move and imagining that he or she is actually observing the missing limb moving. Studies have found that this exercise helps relieve phantom pain in a significant number of people.
Treating Phantom Limb Pain with Mirror Box Therapy.
Minimally invasive therapies
Injection. Sometimes injecting pain-killing medications — local anesthetics, steroids or both — into the stump can provide relief of phantom limb pain.
Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord can sometimes relieve pain.
Intrathecal delivery system. This procedure allows medication to be delivered directly into the spinal fluid. Much lower doses of medication are needed with this route of delivery. It can be useful for people who experience pain relief with oral medications, but who can't tolerate the side effects.
Surgery. Surgery may be an option if other treatments haven't helped. Surgical options include:
Brain stimulation. Deep brain stimulation and motor cortex stimulation are similar to spinal cord stimulation except that the current is delivered within the brain. A surgeon uses a magnetic resonance imaging (MRI) scan to position the electrodes correctly. Although the data are still limited, brain stimulation appears to be a promising option in selected individuals.
Stump revision or neurectomy. If phantom pain is triggered by nerve irritation in the stump, surgical resection or revision can sometimes be helpful. But cutting nerves also carries the risk of making the pain worse.