Research shows virtually everyone who undergoes an amputation of an extremity will describe some measure of phantom limb sensation. These are sensory illusions giving the person a sense that the missing limb is still present. The underlying cause of this disorder is not known. However, doctors suspect it may be linked to parts of the central nervous system that retain the memory of the limb before it was amputated. In many cases, the experience is not particularly troublesome and over time the sensation fades. For other patients, the phantom limb sensations become a source of severe pain that can persist for months or years. People who suffered a sudden traumatic amputation or those who have complications following a surgical amputation, are more likely to suffer from this syndrome. The intensity and quality of phantom limb pain are not the same for everybody. The patient may indicate they feel a lengthening or shortening of the phantom limb and its pain.
Diagnosis
Doctors often find during a physical examination of a patient with phantom limb pain that the stump is tender and there is deterioration of tissue around the wound at the tip of the stump. Patients with phantom limb pain may have neuromas or abnormal clusters of nerve cells at the ends of the nerves that have been cut during the amputation. Patients with significant stump pain may respond to diagnostic and therapeutic nerve blocks or injections of anesthetic medication around the painful structures. Phantom limb pain may also respond to nerve blocks used diagnostically to help reduce the irritability of the nerves that lead from the spine to the painful limb.
Treatment
The treatment of phantom limb pain should focus on correcting underlying predisposing conditions, including the development of neuromas or painful bone spurs in the stump. Some of the effects of phantom limb pain can be alleviated with the use of oral medications, which help reduce pain from nerves. The patients are usually started on a low dose and gradually given larger doses to provide the best overall results. Traditional pain medications and non-steroidal anti-inflammatory agents have a limited use when prescribed in conjunction with other therapies. Nerve block treatments can be extremely valuable for stump pain and phantom limb pain. Injections of anesthetics with anti-inflammatory medications around the painful areas of stump neuromas can provide long-term relief in selected patients. Epidural injections or sympathetic blocks containing anesthetics, sometimes in conjunction with anti-inflammatory or pain medications, can be used in the treatment of phantom limb pain. These injections are usually performed near the spine where the nerves originate. These injections are usually given in a short series over several weeks until the symptoms subside or a plateau is reached. Research shows treatment of stump pain occurring immediately after the amputation can be effective in preventing the development of long-term phantom limb pain. This treatment is often performed through a continuous epidural infusion, through a catheter placed either before or immediately after surgery. Earlier placement seems to be more effective. For some patients surgery is considered in order to remove the painful neuromas at the tip of the stump or to revise the scar at the end of the stump. Rehabilitation efforts to desensitize the painful area, including physical therapy methods, are sometimes utilized.
For patients who have severe pain affecting their ability to perform daily life activities, a combination of physical therapy and behavioral therapy can be utilized. Patients may be asked to complete broad examinations to help determine physical and mental statuses in order to determine what type of behavior modification will be most helpful. Most often patients will find counseling, biofeedback and relaxation techniques the most beneficial.
The Priority Health Spine Centers of Excellence program was created to ensure that all patients with persistent neck pain, back pain or other spine-related problems receive a comprehensive, non-surgical medical evaluation for their condition. For patients whose condition does not require urgent or emergent surgical intervention, an evaluation by a certified Priority Health Spine Center of Excellence is required prior to any referral to an orthopedic or neurosurgeon for back or neck care.
Tri-County Pain Consultants, PC is honored to be recognized by Priority Health as a Spine Center of Excellence for West Michigan. Our team of pain management specialists have a proven track record providing high quality medical care that meets and exceeds the strict criteria required by Priority Health for a Spine Center of Excellence designation.
Acupuncture
Acupuncture is the practice of using small needles inserted at very precise points on the body to promote natural healing and improve functioning. Acupuncture stimulates nerves, muscles and connective tissues, prompting increased blood flow to injured areas of the body, boosting the body’s natural healing process. Acupuncture provides a low risk treatment option that can be beneficial for pain syndromes due to an injury or associated with chronic degenerative diseases.
Cryoablation
Cryoablation is a procedure done in office that utilizes a specially equipped needle guided under fluoroscopy to freeze the area surrounding a nerve that is causing pain or discomfort. The goal of cryoablation is to interrupt the nerve’s ability to send pain signals to the brain and provide pain relief.
Discography
A discography is a diagnostic tool your pain management specialist may use to help determine the disc or discs that are the source of your pain. For this procedure, a contrast dye is injected into the gel like center of the suspected disc or discs, allowing your pain physician to see cracks or leaks in the disc membrane. Typically a patient receiving a discography will be given a local anesthetic or numbing agent. All discographies are performed by a certified pain management specialists under fluoroscopy.
IDET
IDET, or Intradiscal Electrothermal Therapy, is a procedure used to treat discogenic back pain. IDET involves the use a heated probe inserted into the gel like disc which heats up the inside of the affected disc. Heating the inside of the disc can destroy pain causing nerve fibers and seals any cracks or holes in the disc.
Intrathecal Pump Therapy
An intrathecal pump is an implanted medical device that delivers pain medication directly to the intrathecal space surrounding the spinal cord. An intrathecal pump is indicated in cases where patients have difficulty with oral medications or where previous pain interventions have been ineffective.
Kyphoplasty
Kyphoplasty is a procedure designed to help relieve pain caused by compression fractures of the spine. During a kyphoplasty procedure, a small tube is inserted into the fractured area. Once the tube is in place, the physician inflates a small balloon within the fractured area to raise the area, returning the broken pieces to a more normal position. The balloon is then deflated and the space is filled with a bone cement, effectively stabilizing the fractured area.
Manual Therapy
Manual therapy, or manipulative therapy, is a direct contact physical treatment used primarily to treat musculoskeletal pain and disability, intended to restore joint or soft tissue mobility. Treatment may include joint mobilization and manipulation, muscle stretching, and resistance therapy to advance muscle timing and activation.
Medication Management
Mecication Management is medical care provided by your pain management physician to optimize the use of prescribed medication to improve therapeutic outcomes for patients.
Nerve Block Technique
A procedure in which an anesthetic agent is injected directly near a nerve to block pain. A nerve block is a form of regional anesthesia.
Occupational Therapy
Occupational therapy is a task orientated treatment program designed to help patients regain their ability to perform daily living and work activities after serious illness injury or disability. Therapy focuses on the facilitation of daily tasks of self-care, work, and play/leisure activities, to help patients regain the ability to perform daily living and work activities.
Radiofrequency Lesioning
Radiofrequency lesioning is an advanced procedure using a specialized machine to interrupt nerve conduction on a semi-permanent basis. The nerves are usually blocked for 6–9 months. The procedure is typically most effective in treating joint pain in the spine.
Spinal Cord Stimulation
A spinal cord stimulator is a small electrical device implanted just under the skin in the lower back that delivers low level electrical signals to tiny electrodes implanted in the epidural space of your spine. These electrical pulses interrupt the pain signal from reaching your brain, replacing them with a mild tingling in the area where pain is felt. The device is controlled through a magnetic remote control, which allows patients the ability to turn the device on or off, and adjust the intensity as needed.
Stress Management
Stress management is clinical therapy designed to help individuals cope with or lessen the physical and emotional effects of strain and anxiety. Stress-management may include relaxation techniques, time-management skills, counseling or group therapy, exercise, and maintaining an overall healthy lifestyle.
