Phantom pain
Treatment and therapy
There are a number of approaches to therapy for phantom pain, e.g. treatment with drugs, neural therapy, physical therapy or phantom pain treatment with medical devices with a shielding action.
Prevention
An important factor in the prevention of phantom pain is to treat pain that already exists before the amputation. According to what we know today, the best preventive course of action to prevent phantom pain is to start pain control even before the amputation. After the operation, electric stimulation techniques applied to the residual limb are effective for preventing phantom pain. And last, but not least, it is vital that the prosthesis fits well.
Differential diagnosis
The patient must be examined for local causes if phantom pain develops. These can often only be identified by additional examinations. Local causes can be poor blood supply, inflammation (superficial or deep infections), nerve disorders (e.g. a slipped disc with radiation into the phantom limb) or neuromas (caused by scar displacement or poorly fitting prostheses). An amputation neuroma is a growth-like thickening of a nerve stump in the scar region after amputation of a limb, and it is painful to pressure. If the doctor diagnoses phantom pain, there are a number of different therapeutic approaches: medicinal treatment can be given with conventional pain-killers in combination with vitamin B complex and folic acid and/or with psychopharmaceuticals that inhibit pain directly (e.g. antiepileptics such as carbamazepine and valproic avid) and various antidepressants. Weak (Oxycodon, Tillidin) or strong (morphine) opiates can be prescribed depending on the pain intensity. Capsaicin ointment helps against hypersensitivity of the residual limb. Calcitonin infusions are most effective, but the mechanism of action is not yet known.
Therapy with Umbrellan medical devices
Electromagnetic effects are counted as a possible trigger for phantom pain ("sensitivity to the weather"). The metallurgic knit Umbrellan can shield the residual limb against external influences and reduce phantom pain without side effects. For more information on treatment with medi RELAX medical devices, see Stolperstein's Chapter RELAX Products.
Neural therapy
Neural therapy means the treatment of pain by injecting around a certain region with a substance for local anaesthesia. As a result, this inhibits the conduction of stimuli and reduces pain. Trigger point infiltration or a blockade of the sympathetic nerves, are particularly suitable for treating phantom pain. In trigger point infiltration, pain points in the muscles are injected. Sympathetic nerve blockade is achieved by injecting around large nerves that supply the painful region.
Physical therapy
Here we have the choice of massage, hydrotherapy and physiotherapy. Another form of physical therapy is TENS (Transcutaneous Electric Neurostimulation). For this method, the transmission of pain is inhibited by nerve stimulation with electricity from electrodes fixed to the skin.
Complementary techniques
Experience reports have shown that acupuncture, hypnosis and biofeedback are very successful in pain therapy. In many cases, these methods allow a considerable reduction in the consumption of medicines. The efficacy must be tested on a case-to-case basis.
Psychological care
Psychological care can reduce pain at several levels. On the one hand, we have relaxation techniques such as autogenic training or progressive muscle relaxation (PMR). On the other hand, therapies that aim to help cope with the amputation are also very useful.