Does the missing limb still hurt? What is Phantom Limb Pain? Let's talk about it!

Have you ever wondered if you could feel pain in the missing part of your body, say an arm or a leg, after having a surgery to remove it? It sounds a little strange, doesn't it? But this is actually something that some people experience. This is what doctors call (Phantom Limb Pain) . Simply put, "pain in the missing limb". Let's talk about this in a little more detail today, because this is something that many people don't really know about, but it's worth knowing.

What exactly is Phantom Limb Pain?

Simply put, phantom limb pain is the real pain you feel in a part of your body, such as an arm, leg, or finger, that has been surgically removed. You may think, "Oh, that part isn't there anymore, so how can it hurt?" That's true, but the pain you're feeling is real pain . For some, this pain can feel like a very subtle, slight ache. For others, it can be unbearable. Also, this pain can last for a few seconds, a few hours, a few days, or even longer. The best part is, there are treatments for this condition, so a doctor can help you manage this pain.

Are there any types of pain and sensations like this?

Yes, after having a limb removed, you can experience a variety of sensations. Not all of these are accompanied by pain. Doctors call these sensations "phantom." That means "missing." We can mainly distinguish several types:

• Phantom Pain: This is the main thing we're talking about. It means feeling pain in the arm or leg that was removed.
• Phantom Sensations: This is when the amputated arm or leg feels like it is still part of the body . But there is no pain. Instead, you may feel things like touch, pressure, itching, heat, cold, tickling, or vibration. For example, someone who has had a leg amputated may try to walk on both legs, thinking that the leg is still there.
• (Phantom Pain Syndrome) - A condition with pain and sensation in the missing limb: Here, along with the pain, other sensations such as touch , pressure, and itching mentioned earlier are felt simultaneously.
• Residual Limb Pain or Stump Pain: This is a bit different. This is pain that is felt in the remaining part of the body (stump) after an arm or leg has been removed. This usually has a medical cause. For example, it could be an infection in the wound or nerve damage.

How common is Phantom Limb Pain?

This is actually more common than you might think. Research has found that more than half of people who lose a limb experience this (Phantom Limb Pain).

How does this pain feel?

Phantom Limb Pain can be experienced in many different ways. It's hard to say exactly what it is, as it varies from person to person. But the most commonly reported symptoms include:

• Aching
• Like a burning (Burning)
• Itching
• Numbness
• Like someone is pinching (Pinching)
• Tingling
• Sharp stabbing pain
• Temperature change (like heat or cold)
• Throbbing
• Twisting

You may also think and feel the following things about your missing arm/leg:

• It still seems to be stuck to the body.
• It seems to be in a strange, awkward position.
• It seems to be moving back and forth.
• It seems to be gradually shrinking, getting smaller.

Imagine, you have one of your legs removed, but you still feel like your toes are numb, or like someone is squeezing them. That's what this is like.

When does phantom limb pain start to occur?

Many people say that they start to feel phantom pain within the first six months after having a limb removed. After that, the intensity and frequency of the pain usually gradually decrease. However, research has shown that some people can still have some level of phantom pain up to two years after surgery.

What are the triggers for this pain?

Sometimes, phantom pain can start suddenly, or the pain can get worse due to:

• Fatigue​
• Stress
• Anxiety
• Depression
• An infection - especially in the stump
• Blood flow issues
• Pressure or swelling on the remaining part (stump).

Why does this (Phantom Pain) occur?

Doctors still haven't figured out the exact cause, but many believe it's a communication error in our nervous system.Because it's something else. This is what happens, the peripheral nerves in our body send signals to our spinal cord and brain. These signals are what help our body move and feel. Now, after a part like a limb is removed, even though the nerves in that removed part are gone, that nerve connection is still there to some extent in our body . Removing a limb is a big shock to the body. Our brain tries to adapt to this change. Sometimes, in response to such a shock or change, the nerves can "get angry". Then they can send more signals than they normally send, or they can confuse the signals. Our brain misinterprets these signals . This is why the sensitivity is increased and it is felt as pain.

What are the causes of residual limb pain?

As we discussed earlier, the remaining part of the body that was not removed, the stump, can cause pain. Since this part is actually in the body, there are several complications that can cause pain:

• Bruising
• Bone infections (Osteomyelitis) or abnormal bone growths (bone spurs)
• Neuroma, a condition similar to a nerve tumor
• Pain caused by nerve damage (Neuropathic pain)
• Poor blood flow
• Wearing an ill-fitting prosthetic device
• Pressure injuries /bedsores
• Skin or wound infections

Sometimes you can have both phantom limb pain and phantom limb pain at the same time.

(Phantom Limb Sensation) Or why does the sensation of a missing limb occur?

Phantom Limb Sensation is the feeling of touch and movement in a limb without pain. This happens because your brain tries to rewire sensory signals after a limb is removed. Our bodies naturally send signals to our limbs throughout our lives. Now that part is gone, to adapt to this change, the brain has to relearn where to send signals. Just as it takes time to learn something new, it takes time for our bodies to adjust to this change. That's why we experience Phantom Sensations.

Who is at higher risk of developing Phantom Limb Pain?

In fact, anyone who has had a limb amputated can experience phantom pain. However, it is more common in people who have had upper limbs (hands, fingers) amputated . However, it can occur with any part of the body that is amputated. If you regularly use a prosthetic device, you may experience more pain when it is removed.

What complications can occur due to this pain?

Living with pain is not easy. Phantom Limb Pain can have a significant impact on your mental health . In some cases, it can even lead to anxiety or depression . Because of the pain you feel:

• You may not be able to sleep properly.
• You may not be able to complete your daily tasks properly.
• You may not be able to participate in the things you enjoy doing.

Therefore, it is very important to seek help from a doctor to control this pain.

How do doctors diagnose phantom limb pain?

A doctor will examine you and, if necessary, perform several tests to determine whether this is Phantom Limb Pain.

• First, they ask you questions to find out what you are feeling and how you are feeling.
• Then, the skin where the limb was removed is examined for any wounds or signs of infection.
• Blood tests or imaging tests may also be done to see if there are other causes for the pain.

Since amputation can have a significant psychological and emotional impact, your doctor may also recommend a psychological evaluation . Phantom Pain can also be exacerbated by factors such as stress, anxiety, and depression. Therefore, it is important to identify and treat the exact cause of the pain.

What are the treatments for phantom pain?

There are several treatments for phantom limb pain. Your doctor will choose the one that best suits your condition. The main treatments are:

• Medications
• Mirror therapy
• TENS therapy (Transcutaneous electrical nerve stimulation) - electrical nerve stimulation through the skin.
• Spinal cord stimulation
• Neurostimulation therapy
• Stump revision surgery - in some special cases.

In addition, complementary therapies such as these may also provide relief:

• Acupuncture
• Biofeedback therapy
• Cognitive behavioral therapy (CBT)
• Massage therapy
• Meditation or mindfulness exercises

You may be able to get by with just one treatment, or you may need to do several treatments together.

What is Mirror Therapy?

This is a very simple, yet effective method. What happens here is that you "trick" your brain by using a mirror.Something like that. That is, the brain is convinced that the amputated arm/leg is still there. In this treatment, there is a mirror on the side where the amputated arm/leg is. Then, when you look in the mirror, you see your healthy other arm/leg. The mirror image makes it look as if the missing arm/leg is still there. Then, a doctor or physiotherapist tells you to do certain movements with the healthy arm/leg, and you have to look at it in the mirror. This makes the brain think that you have both healthy limbs . You have to do this exercise for about 20 minutes a day. Over time, the brain processes this information. Since the brain thinks that the missing arm/leg is still there, the signals sent between the nervous system are not confused. Then the pain is reduced.

What are the medications for Phantom Limb Pain?

The types of medications given may vary depending on your needs. The most commonly used types of medications are:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) - e.g. Ibuprofen, Diclofenac.
• Prescription pain relievers
• Antidepressants - These are sometimes given for pain.
• Antiseizure medications - e.g. `Gabapentin`, `Pregabalin`. These are also given for nerve pain.
• Beta-blockers - e.g. Propranolol.
• Calcium channel blockers - e.g. Nifedipine.
• Botulinum toxin B injections - in some cases.
• Local anesthetic infusions - e.g., those containing Lidocaine or Bupivacaine.

Like all medications, side effects can occur. Therefore, your doctor will inform you about them when you start treatment.

Is there a way to prevent phantom limb pain?

In fact, there is no proven way to completely prevent phantom limb pain after amputation. However, some studies suggest that using both spinal anesthesia and general anesthesia during amputation may reduce the risk of phantom limb pain.

What can you expect if you have Phantom Limb Pain?

When you first experience phantom limb pain after having a limb amputated, you may feel very anxious and confused . You may wonder, "Why am I feeling this pain in a place that isn't there?" This type of pain may be new to the body, but it is common for people who have had a limb amputated.. This pain can interfere with your daily activities and sleep. The best thing is, doctors can help you manage this pain. There are many treatments that can be tailored to your needs. Also, having a limb removed can affect your mental health. Therefore, talking to a mental health counselor to manage stress, anxiety, and depression that are causing phantom pain may also be part of your treatment plan.

How long can these (Phantom Pains) last?

It's hard to say exactly how long phantom limb pain will last. It can be temporary or chronic . The pain can last for seconds, minutes, or even days. It varies from person to person. For most people, it's most intense in the first six months after the limb is removed, and then it gradually subsides as the body adjusts to the changes. However, there are treatments that can help reduce the impact of this pain on your life.

What are the best times to see a doctor?

If you have any of these things, definitely see a doctor:

• If the pain interferes with sleep or daily activities .
• If there are signs of infection in the residual limb (e.g. fever, skin discoloration, swelling, pus).

The bottom line: Phantom Limb Pain is a condition that many people experience after losing a limb. Feeling pain in the missing limb can make you feel anxious, embarrassed, and even think, "Am I crazy?" But the pain you're feeling is real . So don't ignore it. Your doctor can help you. This pain usually gets better with time.

Finally, things to remember

So, Phantom Limb Pain is a bit complicated, but it's understandable. If you or someone you know has this condition, keep these things in mind:

• This is real pain: it's not just something you think.
• You are not alone: ​​many people have this experience.
• There are treatments: you can get help to control the pain and make life easier.
• Talk to a doctor: Don't be shy or afraid. Talk openly about your condition.
• Mental health is also important: get help for that too if needed.

I hope this information is useful to you. Stay healthy!

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