Phantom Limbs

Introduction

A feeling that develops after the amputation of a limb in which removed limb is still felt to be attached to the body and performing its function is known as phantom limb. Nearly 60 to 80 percent patients have this type of feeling in their missing limb that is mostly painful. But this phantom sensation is not confined to the missing limbs only but it may also occur in other parts of the body after their amputation like removal of tooth leads to phantom tooth pain, whereas extraction of eye causes phantom eye syndrome.

Symptoms

There is a pain in the missing limb but not in all cases. Sometimes patients feel cramps and itching. Patient feels as its missing limb is shorter than the normal limb and it is not in normal position and therefore patient is feeling pain. This pain could be severe due to weather changes, stress and anxiety. This is actually an irregular type of pain and its severity decreases with the passage of time.

This syndrome is also being reported in those people who have passed through gender reassignment surgery. They are suffering from phantom genitals. It is unusual in operative transwomen but common in transmen. Similarly, phantom breast is reported from patients who have passed through mastectomy. This is usual in post-operative transwomen but less usual in transmen.

Cause of Phantom Limb

There is no exact cause known for phantom pain till now but there is a hypothesis formulated by the researchers. According to this hypothesis, when the limb is amputated then the nerves that were performing their functioning in that limb were also terminated as a result of which these nerves swell and when these nerves conduct signals to the brain then there is no functional meaning of that nerve impulse and thus brain interpret this nerve impulse as a pain. But this hypothesis is not much believable because the attempts made to treat phantom limb on the basis of this hypothesis failed and hence proved that this is not acceptable hypothesis.

For the treatment of this disease in severe cases, surgeons usually remove the remaining part of limb and hence shortening the limb as a result of which there is a temporary relief from the pain. But unfortunately, it has been observed that these patients were suffering from more pain after further amputation of limb. It was noticed that there was the same sensation in the new phantom stump as well as the pain due to the original limb was still present. In some of the cases the surgeons cut the nerve leading to spinal cord and even in a few cases the surgeons delete the part of hypothalamus that usually receives the nerve impulse from the body.

Treatment

The attempts to treat this anomalous pain over the past two decades were not successful and there was no appreciable recovery of the syndrome. For the treatment of this disease in severe cases, surgeons usually remove the remaining part of limb and hence shortening the limb as a result of which there is a temporary relief from the pain. But unfortunately, it has been observed that these patients were suffering from more pain after further amputation of limb. It was noticed that there was the same sensation in the new phantom stump as well as the pain due to the original limb was still present. In some of the cases, the surgeons cut the nerve leading to spinal cord and even in a few cases the surgeons delete the part of hypothalamus that usually receives the nerve impulse from the body.

Moreover, use of antidepressants, acupuncture, vibration therapy, and hypnosis is proved a little bit effective in relieving from the phantom pain. Morphine or ketamine is used during the surgery. Morphine is also helpful in long term use.

During the past few years, mirror box is widely used by the patients. It actually provides a reflection of the remaining hand or limb and this allows moving the amputated limb from the position that is painful.

Further Information

Phantom Limbs: A Neurobiological Explanation – http://serendip.brynmawr.edu/exchange/serendipupdate/phantom-limbs-neurobiological-explanation

The Hand That Never Was: Supernumerary Phantom Limbs – http://sites.bu.edu/ombs/2011/03/02/the-hand-that-never-was-supernumerary-phantom-limbs/