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What Causes Phantom Limb Pain?

Jenny L.F. Andrus, MDBy Jenny L.F. Andrus, MD

In my last blog post, I discussed phantom pain and the symptoms typically seen in those who have had limbs amputated. In this post, I will discuss the theories about why this condition exists and the medications that are used to treat phantom pain.

Although the exact cause of phantom limb pain is not known, it has been found to occur in the brain and spinal cord. The brain is wired to perceive sensation from each of our limbs. Once the sensory input to the brain from the limb is removed, pain occurs. Phantom limb pain does not occur in all people who have had amputations. It is not certain why some people are affected, however, studies have shown factors that increase the risk of developing phantom limb pain. These include having pain in the limb prior to amputation, having stump pain, as well as wearing a poorly fitting prosthetic.

When I see a patient with phantom pain, I will take a detailed medical history, perform an examination and review prior medical notes. I find that I ask a lot of questions about the person’s pain to try and better understand how it impacts them and their activities.  I ask them about their usage of medication, including narcotics, to understand what works and what does not seem to work for their pain.

When I feel I have a complete picture of the patient, I can then recommend treatments which I feel will provide the best chance of significantly reducing their pain and helping them get back into life. Treatment of most chronic painful conditions, including phantom limb pain, is best done as a multi-modal approach. There is no one specific treatment that eradicates all phantom limb pain. There are several medications commonly used to treat nerve-related pain. These include some types of antidepressants and some anti-epileptic medications. These work in various ways to reduce the transmission of nerve pain. In some patients, narcotic pain medications are necessary. Often a combination of medications from different classes will provide the most relief.

Learn about non-pharmaceutical treatments for phantom limb pain.

Jenny L. Andrus, MD is a Board-Certified, Fellowship-trained Interventional Pain Management Specialist with Orthopaedic and Spine Center in Newport News, VA.  To schedule an appointment with Dr. Andrus, please call 757-596-1900.

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