What is the cause of phantom pain? How does an amputated limb hurt? Phantom pains and how to get rid of them Phantom pains neurology

Clinical case of treatment of a patient with post-traumatic amputation phantom pain syndrome

Patient F., 56 years old, an electrician, a resident of Novosibirsk, applied to the Pain Treatment Clinic of Professor Sokov E.L. 05/05/2009, with complaints of severe pain burning, shooting, boring, penetrating, debilitating nature, accompanied by a feeling of fear of pain in the fingers of the left completely amputated limb. Unbearable severe pain with an intensity of 10 points on a 10-point pain scale was provoked by touching the fabric of a shirt, a breath of wind, touching water, etc. Rehabilitation and prosthetics of the stump were impossible due to the maximum pain syndrome that could not be treated.

The patient constantly daily for 5 years takes a solution of diphenhydramine 1% up to 30 ml per day (3 packs of 10 ampoules), i.e. pregabalin 600 mg * 3 times a day, amitriptyline 25 mg * 6 tablets per day, tramal 1 ml * 3 once a day intramuscularly, tramala retard capsules 200 mg * 4 times a day inside, spasmalgon 10 tablets a day, solpadein 6 effervescent tablets a day, codeine + paracetamol tablets - 20 pcs. per day. The effect of the treatment is not noted. The pain syndrome decreases during the day slightly. The patient attempted suicide three times in the last year. Three times examined by MSEK, has 1 disability group, indefinitely.

From the history of the disease: In 2004, he received an industrial injury. During the repair of a de-energized high-voltage power line, which the patient held on to with his hand, someone turned on the switch and let an electric current of 6000 volts flow through the line. The patient received an electrical injury - the left arm burned up to the middle of the humerus in front of the patient's eyes, on the right arm there was a 3 degree burn of the hand. The patient then fell to the ground. In critical condition, the patient was taken to the surgical department, where an emergency operation was performed - amputation of the left humerus, amputations of 1-3 fingers of the right hand. Within a month the patient was in intensive care, then within 4 months he underwent repeated reconstructive operations on his hands, plastic surgery with a skin flap of the right hand. He was discharged home for outpatient rehabilitation. Pain in the fingers of the amputated left hand appeared and began to gradually increase after the healing of postoperative wounds. Analgesics were prescribed, which did not bring any effect. The patient began to experience problems in self-service: because of the pain syndrome, he could not wash himself, get dressed, refused to eat, and had difficulty going to the toilet. The slightest irritation of the skin or hair on the skin of the right hand began to provoke an attack of severe pain in the amputated left limb. It was decided to refrain from rehabilitation measures and prosthetics of the stump of the left hand. The patient gradually began to increase the dose of painkillers, then tramal was prescribed. In addition, the patient himself began to use painkillers uncontrollably. He became gloomy, taciturn, anxious, sometimes aggressive. Consulted by a psychiatrist repeatedly, the recommended treatment was ineffective.

When contacting the Pain Treatment Clinic, he stated that this is the last instance of hope, if at least some clinical effect is not achieved, then his life is over.

When examined by a neurologist of the Pain Treatment Clinic of Professor Sokov E.L. pain syndrome on a 10-point scale was 10 points, the patient was crying from pain.

On palpation, severe pain was determined in the area of ​​the spines of the shoulder blades, the stump of the left shoulder, the stump of the right hand.

On radiographs of the left shoulder joint - osteoporosis of the bones of the left shoulder blade, left clavicle.

In a day hospital, the patient underwent intraosseous blockades in the spine of the scapulae, heads of the clavicle, spinous processes of the cervical spine - a total of 26 blocks within 14 working days.

After the first procedure in the spine of the left and right shoulder blades, the pain syndrome decreased by 10-15%, the pains were no longer provoked by the touch of the shirt fabric, the mood improved somewhat, and he stopped expressing suicidal thoughts.

After the fifth procedure, the pain syndrome in the amputated limb regressed by 50% of the initial level. The patient completely refused tramal. I began to notice the effect of taking analgesics, my sleep and mood improved, I began to dress and eat on my own. I enjoyed walking around Moscow.

After the 10th procedure, the pain syndrome remained at the level of 50% of the initial level. However, the number of drugs taken was reduced by 2 times.

After the 14th procedure, the pain syndrome decreased by 80%, the patient refused all drugs except for 6 ml of diphenhydramine solution per day.

After 6 months, the patient called the Pain Clinic of Professor Sokov E.L. and reported that the pain syndrome in the amputated left limb is 4 points and is characterized as moderate, the patient visits the pool, prosthetic left limb. Does not take analgesics. There are no suicidal thoughts.

Phantom pain is one of the most serious chronic pain syndromes. The first descriptions of phantom pain were made as early as the 16th century, but even today, after almost half a millennium, scientists still do not understand the mechanisms that underlie its appearance. This is one of the most mysterious medical phenomena - even after an amputation, a person feels strong, ongoing pain in those limbs that were amputated. Phantom pains have not been studied enough, and many people doubt the prospects for their elimination.

Phantom pain occurs after the amputation of a limb, but this term is also used to describe pain after the amputation of any part of the body. Cases of phantom pain after tooth extraction, mastectomy have been described. In modern medicine, there are more than forty methods of treating phantom pains, but only 15% of patients manage to completely get rid of these sufferings.

Some of the patients feel pain rarely, some people suffer regularly. Phantom pains vary greatly in intensity - from annoying and annoying to unbearable, in which performance is completely impaired.

Treatment methods for phantom pain

One of the possible explanations for the appearance of phantom pain is the fact that after amputation of a limb, a huge number of nerve endings on the stump continue to send impulses to the brain. The essence of surgical treatment in an attempt to reduce phantom pain is to interrupt pain impulses in different parts of the central or autonomic nervous system. Such methods include sympathicotonia - suppression of the sympathetic trunk of the autonomic nervous system, operations on the subcortical formations of the brain (thalamic nuclei), dissection of the nerve trunks at the site of the stump.

For the treatment of phantom pain, blockades of sensitive areas of the stump are practiced by local administration of anesthetics. These blockades in some cases stopped the pain for several hours, less often for several days or weeks, occasionally the pain after the blockade went away forever.

One of the methods of treating phantom pain is based on the existence of areas of increased sensitivity, the touch of which increases the intensity of phantom pain. A solution is deliberately injected into these areas, which stimulates the appearance of pain. Artificially induced pain in the phantom limb lasts no more than ten minutes, and then partially or completely disappears for a long time, or forever.

Sometimes patients with phantom pain are relieved by vibration stimulation or electrical stimulation of the muscles of the stump. In some cases, electrodes are surgically placed on the spinal cord.

Prevention of phantom pain

Observe what factors can cause or exacerbate your phantom pain. For each person, these situations are individual. Try to avoid them.

Some patients report discomfort and even pain when the stump of an amputated limb is in a free-suspended state. Choose a position of the body that is comfortable for the stump, make it a habit, try to constantly adhere to such a position so that pain does not occur.

Often, regular light and gentle massage of the lower part of the stump, the area of ​​​​the surgical suture, helps to relieve pain. You can alternate massage with rubbing the limb with tissues of different textures so that the stump gets used to new sensations.

If you are familiar with the basics of yoga, try one of the relaxation techniques. At the same time, try to move a healthy limb, imagining how the amputated part of the body moves.

Prosthetics or physiotherapy have an analgesic effect in the treatment of phantom pain, in addition, these methods are the basis of the rehabilitation program, their use helps to restore the patient's motor function.

Common pain relievers such as ibuprofen, aspirin, or acetaminophen can help relieve persistent but not severe pain. In addition, some temporary relief is provided by antidepressants and muscle relaxants, anticonvulsants. Do not abuse their use, it is better to consult with your doctor about taking these drugs.

The effectiveness of mirror therapy in the treatment of phantom pain

Scientists from the American Medical University in Maryland conducted a small study, the purpose of which was to compare the effectiveness of mirror therapy with psychological imaging methods in the treatment of phantom pain. During the experiment, a mirror box was put on the stump of an amputated limb, in which a healthy limb was reflected.

The method, proposed back in 1995 by Professor Vilayanur Ramachandran, consists in an elementary "deception" of the brain. When a patient sees a reflection of a healthy arm or leg instead of the amputation site, their brain begins to perceive the reflection as a real image of the amputated limb. Patients aggravated the deception of the brain by moving the fingers of a healthy limb. In the future, patients tried to mentally move the fingers of the amputated leg or arm.

The results of the experiment showed that all patients from the group who experienced mirror therapy reported a decrease in phantom pain (100%). In the second group, where psychological imaging sessions were performed, while patients mentally imagined their amputated limb, phantom pain increased in 67% of patients. Thus, it has been proven in practice that the use of mirror therapy helps to reduce phantom pain in patients with amputated lower limbs, this method can be used to treat patients with phantom pain.

Modern prosthetics in the fight against phantom pain

As already mentioned, prosthetics can produce an analgesic effect. After amputation, a huge number of sensory and motor nerves remain, which continue to send impulses to the brain from a non-existent limb, which, possibly, leads to the appearance of phantom pains. Based on this phenomenon, scientists have attempted to create a new generation of prostheses. They set themselves a difficult task: to ensure that the patient feels everything that the prosthesis touches, so that he can control the artificial limb with the power of thought.

The new technique, which was called “guided muscle reinnervation,” was implemented by bioengineers and physicians at the Chicago Institute of Rehabilitation. For patients with phantom pain, a bionic hand prosthesis was created, the work of which is regulated by the nerve fibers of the hand.

The first owner of a miracle prosthesis, Claudia Mitchell, can use it to wash dishes, cut bread and perform other actions. Now the teachings from this institute hope to create an artificial leg using a similar technique in the near future.

Dr. Weiss' team at the University of Jena is currently working on another technology that they plan to use to help patients get rid of phantom pain. The essence of the method is to organize feedback between the artificial limb and the brain, thanks to which it is possible to completely eliminate pain sensations due to the reorganization of the brain. I hope they will be able to solve not only the problem of phantom pain, but also the excessive cost of such prostheses.

Nociception

According to the International Association for the Study of Pain, a distinction must be made between pain and nociception. Term pain denotes a subjective experience that is usually accompanied by nociception, but it can also occur without any stimulus.

Nociception is a neurophysiological concept that refers to the perception, conduction and central processing of signals about harmful processes or influences. That is it physiological mechanism transmission of pain, and it does not affect the description of its emotional component. Of great importance is the fact that the conduction of pain signals in the nociceptive system itself is not equivalent to felt pain.

phantom pains

Although, as a rule, pain accompanies damage or inflammation, being a response to it, often the occurrence of pain is possible without damage.

This phenomenon is observed in amputees and consists in the sensation of the amputated limb, including pain effects in it.

Physiological role

Despite its unpleasantness, pain is an essential component of the body's defense system. This is the most important signal about tissue damage and the development of a pathological process, a constantly acting regulator of homeostatic reactions, including their higher behavioral forms. However, this does not mean that pain has only protective properties. Under certain conditions, having played its informational role, the pain itself becomes part of the pathological process, often more dangerous than the damage that caused it.

Types of physical pain

• acute pain defined as pain of short duration with an easily identifiable cause. Acute pain is a warning to the body about the current danger of organic damage or disease. Often persistent and sharp pain is also accompanied by aching pain. Acute pain is usually concentrated in a certain area before it somehow spreads wider. This type of pain usually responds well to treatment.

• chronic pain originally defined as pain that lasts for about 6 months or more. It is now defined as pain that stubbornly persists beyond the appropriate length of time during which it should normally end. It is often more difficult to heal than acute pain. Particular attention is required when addressing any pain that has become chronic. Of course, in some extreme cases, when things go too far, neurosurgeons can perform complex surgery to remove parts of the patient's brain to deal with chronic pain. And then postoperative patients will still continue to feel pain, but they will not feel any accompanying emotions.

Sensations of physiological pain are divided into groups according to the causes of occurrence and the associated nociceptors (pain receptors).

• Skin pain occurs when the skin or subcutaneous tissues are damaged. Cutaneous nociceptors terminate just below the skin and, due to their high concentration of nerve endings, provide a highly accurate, localized sensation of pain of short duration.

• Somatic pain occurs in ligaments, tendons, joints, bones, blood vessels, and even in the nerves themselves. It is determined by somatic nociceptors. Due to the lack of pain receptors in these areas, they produce a dull, poorly localized, longer lasting pain than skin pain. This includes, for example, sprained joints and broken bones.

• inner pain arises from the internal organs of the body. Internal nociceptors are located in organs and in internal cavities. An even greater shortage of pain receptors in these parts of the body leads to the appearance of more nagging and prolonged pain compared to somatic pain. Internal pain is particularly difficult to localize, and some internal organic lesions are "attributed" pains, where the sensation of pain is attributed to a part of the body that has nothing to do with the site of the injury itself. Cardiac ischemia (insufficient blood supply to the heart muscle) is perhaps the most famous example of pain attributed; the sensation can be located as a separate feeling of pain just above the chest, in the left shoulder, arm, or even in the palm of your hand. The attributed pain may be due to the discovery that pain receptors in the internal organs also excite spinal neurons that are activated by skin lesions. Once the brain associates the firing of these spinal neurons with stimulation of somatic tissues in the skin or muscles, pain signals coming from the internal organs begin to be interpreted by the brain as coming from the skin.

• Phantom limb pain is a sensation of pain that occurs in a lost limb or in a limb that is not felt with the help of ordinary sensations. This phenomenon is almost always associated with cases of amputation and paralysis.

• neuropathic pain, or "neuralgia", may appear as a result of damage or disease to the nerve tissues themselves. This can impair the ability of the sensory nerves to transmit correct information to the thalamus (a part of the diencephalon), and hence the brain misinterprets pain stimuli, even if there are no obvious physiological causes of pain.

Physiology

According to one hypothesis, pain is not a specific physical sensation, and there are no special receptors that perceive only pain stimulation. The appearance of a feeling of pain can be caused by irritation of any type of receptor, if the strength of the irritation is high enough.

According to another, more common at the moment point of view, there are special pain receptors, characterized by a high threshold of perception. They are excited only by stimuli of "damaging" intensity.

According to the second hypothesis, all pain receptors do not have specialized endings. They are present as free nerve endings. There are mechanical, thermal and chemical pain receptors. They are located in the skin and in internal surfaces such as the periosteum or articular surfaces. Deeply located internal surfaces are weakly connected with pain receptors, and therefore the sensations of chronic, aching pain are transmitted only if organic damage has arisen directly in this area of ​​the body.

It is believed that pain receptors do not adapt to external stimuli. However, in some cases, the activation of pain fibers becomes too strong, as if pain stimuli continue to recur, leading to a condition called "pain hypersensitivity" (hyperalgesia). In fact, there are people with different pain thresholds. And this may depend on the emotional and subjective characteristics of the human psyche.

Nociceptive nerves contain primary fibers of small diameter that have sensory endings in various organs and tissues. Their sensory endings resemble small branched bushes.

The two major classes of nociceptors, Aδ- and C-fibers, transmit fast and slow pain sensations, respectively. A class of Aδ-myelinated fibers (coated with a thin myelin sheath) conducts signals at a distance of 5 to 30 meters per second, serves to transmit fast pain. This type of pain is felt within one tenth of a second from the moment the painful stimulus occurs. Slow pain, passed through the slower, unmyelinated ("bare") C-fibers, which send signals to a distance of 0.5 to 2 meters per second, is aching, throbbing, burning pain. Chemical pain (whether poisoning through food, air, water, accumulation of residues in the body of alcohol, drugs, medicines or radiation poisoning, etc.) is an example of slow pain.

Survival

Despite its nuisance, pain is an important part of human existence, as well as other forms of life, and, in fact, it is vital to survival. Pain causes the body to move away from destructive objects or forces that cause painful reactions. Pain, by warning the body, can serve as an indicator that serious damage may soon threaten the body, as, for example, with pain from a bone that is about to break. Pain can also aid the healing process by forcing the entire body to protect the affected area in order to avoid further pain.

Since pain is defined as a signal of existing or potential danger of organic damage, the ability to experience pain or irritation has become a noticeable observation by scientists in most multicellular organisms. Even some plants have the ability to deviate from destructive stimuli. Whether this sensation of pain is akin to what a person experiences is a debatable issue.

Chronic pain, in which the pain becomes more pathological rather than survival value, is a marked departure from the general rule that pain has survival value.

Other points of view

The study of pain has expanded in recent years into fields ranging from pharmacology to psychology to neuropsychiatry. It was previously unimaginable that fruit flies would be used as an object for pharmacological research on pain. Some psychiatrists also try to use pain to find a neurological "substitute" for human awareness, since pain has many subjective psychological aspects besides pure physiology.

Interestingly, the brain itself is devoid of nociceptive tissues, and therefore cannot feel pain. Thus, the headache cannot possibly originate in the brain itself. Some have suggested that the membrane surrounding the brain and spinal cord, called the dura mater, is supplied with nerves with pain receptors, and that these dural (dural) nociceptors are stimulated, and they could probably be involved in the "production" headache. However, some evolutionary biologists suggest that this lack of nociceptive tissues in the brain may even be necessary. They attribute this to the fact that, in this case, no serious injury caused pain to the brain, which would have a high enough chance of being fatal if nociceptive tissues were present, and which would then be useless for the survival of an organism with a serious brain injury.

Alternative medicine

Surveys conducted by the US National Center for Complementary and Alternative Medicine (NCCAM) have shown that pain is a common reason people turn to complementary and alternative medicine (CAM). Among American adults who used CAM in 2002, 16.8% desired a cure for back pain; 6.6% - neck pain; 4.9% - arthritis; 4.9% - joint pain; 3.1% - headache; and 2.4% struggled with recurrent pain.

heartache

heartache is also a loss in survival potential. Only a person does not lose body tissues, cells or physiological functions. He loses close relatives, loved ones, personal belongings, a dog or cat, or he loses status or respect, etc. There are direct parallels with physical pain in that pain is always a loss of something, leading to a threat of death . The psychologist will say that the loss of a person (whether important items or close living beings) leads to a decrease in the factors contributing to his survival, and therefore he "gets upset." Thus, a person confuses the loss of an object that promotes survival with physical pain. This is where the term "heartache" comes from.

Notes

see also

Links

• Virtual reality relieves phantom pain Compulent

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See what "Phantom pain" is in other dictionaries:

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phantom violations- (from the French fantfme ghost) false sensations (pain, itching, anemia, convulsions, etc.) from a non-existent part of the body (for example, after amputation of a limb). F. n. can take on an obsessive, painful character. The missing limb or its ... ... Great Psychological Encyclopedia

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Pain is physical or mental suffering, an agonizing or unpleasant sensation, anguish, distress, the opposite of euphoria. Contents 1 Pain from a medical point of view 2 International definition ... Wikipedia

Keruchenko, Irina Vilyamovna Irina Keruchenko Irina Vilyamovna Keruchenko Place of birth: Molodechno, Belarus ... Wikipedia

phantom limb- - subjective sensation of the existence of a limb (and pain in it - phantom pain) that has been amputated. In fact, it is a hallucinatory replacement of a lost body part, when, as it is believed, due to unknown reasons, neural ... ... Encyclopedic Dictionary of Psychology and Pedagogy

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Often, after the removal of a limb or body part, a person continues to feel it and even feel pain. This phenomenon is called phantom pain (phantom syndrome). We will talk more about this phenomenon in the article.

So, phantom pain - what is it? This is a kind of reaction of the human body to the removal of a body part. Phantom pain can be felt not only in the leg or arm, if they are removed, but also in the teeth, mammary glands, fingers, ears, etc.

Removal of a limb or internal organs can occur for various reasons (diabetes mellitus, trauma, severe illness, etc.) and in any case, phantom-type pain can form.

Phantom pains are:

1. Painless.
2. Painful.

Painless appear as:

• an irresistible desire to scratch the missing part of the body;
• sensation of limb flexion;
• imaginary shortening or lengthening;
• representation of its position in space.

In turn, painful pains are:

• squeezing;
• burning;
• electric shock.

Moreover, the place of occurrence of this pain is different. For example, a person may feel pain in the place where the limb had to be amputated, or the so-called may form.

Pain Options

It may mean that the patient feels severe pain when touching the opposite arm or leg (in case there was an amputation). The pain is so severe that the patient often cries out at such a touch.

The time of occurrence is also different and depends on the individual characteristics of the body of a particular patient.

Some may develop phantom pain immediately after surgery. Someone begins to feel pain after 2-3 months, and someone after a year or several years.

It happens that a person cannot get rid of the feeling of phantom syndrome throughout his life.

A special form can be attributed to phantom toothache - odontology.

Odontology is a toothache that is not related to dentistry.

This ailment can occur as a result of the removal of nerves by a dentist through root resection. Dental phantom pain is less intense than that resulting from amputation of limbs or removal of internal organs.

In addition to the removal of limbs, it is possible that pain develops as a result of the surgical removal of an internal organ (uterus, kidney, etc.). Such pains, according to the description, are also called phantom pains. These pains can be formed in the abdomen and have the same character as when amputating a limb.

Causes

What are the causes that provoke the formation of phantom-type pain syndrome after amputation or after traumatic loss of a limb?

It is believed that such sensations are formed as a result of nervous experiences, psycho-emotional stress, but this is not 100% of cases. The amputated part of the body was removed at the physical level, but the mechanism of the human central nervous system is complex and not fully understood. Perhaps she does not understand that the arm or leg (other limb) is missing and continues to “feel” it and consider it part of the body. And human memories regarding the position of a given part of the body are reproduced in the head. All this combination of causes forms the atypical nature of phantom pain.

Another hypothesis regarding the mechanism of pain formation is the direct connection of the peripheral and sympathetic nervous systems to phantom pain. So, the nerve endings in the amputation site are irritated, which makes the person hurt a little further than the place of irritation.

The most tangible reasons are:

1. Improper closure of the stump after removal and, as a result, the formation of a nerve neuroma.
2. Formation of a focus of pain excitation in the spine (spinal cord).

Symptoms

The main type of phantom pain is as follows:

• krampi - clenching pain;
• neuralgic - electric current;
• causalgic - scorching pains;
• burning - burning in an amputated limb or internal organ.

Two types of pain should be distinguished:

1. Formed by the peripheral nervous system.
2. Formed by the central nervous system.

The fact is that in the event that the culprit is the central nervous system, a significant effect can be from surgical intervention, at a time when the peripheral nature of the pain can be cured with the help of medications.

But in any case, the removed limb cannot hurt, our nervous system is to blame. So, neither the phalanx, nor the tooth, nor even the removed internal organ will in any way make itself felt, the doctor will look for the cause inside.

Several contributing factors:

• the act of defecation or urination;
• pain in any organ or limb;
• psycho-emotional shocks, depression, etc.

Treatment

Getting rid of a painful phantom is not as easy as it seems at first glance. There is no effective remedy, there are only a few options that can ease or eliminate pain.

Distinguish:

• drug treatment;
• surgery;
• physiotherapy intervention;
• psychological help.

The most effective way is complex - a combination of medication, physiotherapy and psychological therapy.

Treatment of phantom disease with medications

It is not so easy to treat phantom pains with the help of pills, since any medical medicine tends to accumulate in the body, and this is not good for the treatment of phantom pains.

The fact is that the longer this or that medication acts on the body, the better it (the body) adapts to its effects and the pain may even increase.

The main drugs prescribed to relieve pain symptoms:

1. Analgesics (Finlepsin, Neurontin).
2. Narcotic drugs.

Doctors can not only prescribe pills or injections, but also carry out sensory, novocaine and case blockades. With the help of the blockade, the doctor can see which nerve is to blame for the occurrence of pain (if, after setting up a novocaine blockade at the site of removal, the pain decreases, it can be judged that it is this nerve ending that is the culprit and you need to fight it).

It is important to know that getting rid of phantom pain is achieved by an integrated approach and surgical intervention is indicated in 45% of cases.

Surgery for phantom pain

It is difficult, but possible, to relieve the patient of the sensations that torment him. Surgical intervention in most cases has a positive effect. But, before prescribing the operation, the doctor must know exactly what the reason is in order to make the right decision.

The operation can be:

• sympathicotonia (surgical intervention in the autonomic nervous system);
• on the nuclei of the thalamus;
• local (reamputation, disarticulation).

The decision to conduct surgery on the nuclei of the thalamus should be taken by the doctor only if the operation on the nerve roots was not successful and the pain has not gone away.

The simplest surgical intervention is a repeated operation at the site of removal, which does not last long and consists in eliminating the consequences of the neuroma of the nerve endings.

Treatment of phantom pain with physiotherapy procedures

In addition to drug therapy and surgery, physiotherapy is an excellent tool to eliminate the consequences of removing a limb or internal organ.

This type of therapy copes well with the main task - the elimination of pain. The main condition is the regularity of procedures, since visiting a physiotherapist once a week will not greatly improve the patient's condition.

Physiotherapy includes:

• reflexology (a set of methods for influencing active points on the surface of the human body - acupuncture);
• UHF electric field;
• acupuncture;
• electrical stimulation;
• hydrocortisone phonophoresis;
• laser therapy;
• massage.

The methods listed above are the basis and are applied at the initial stage. After the main symptoms are removed (how long it takes depends on the intensity), prophylactic agents can be prescribed:

• paraffin therapy;
• mud treatment;
• baths (radon, iodine-bromine, coniferous);
• baths for the stump;
• galvanization;
• diadynamic therapy.

Psychotherapy for phantom pain

Psychotherapeutic help is to influence the mental state of the patient. The best impact of psychological methods is possible with an integrated approach (medication and psychiatry).

The most common way to eliminate phantom pain on a psychological level is to use a mirror.

Removing phantom pain with it is easier than it seems. So, the patient puts a mirror on the limb opposite to the healthy one, in which it will be reflected, misleading the brain.

The brain, seeing a reflection of a healthy one in the place of the removed limb, will consider it its own and the foci of pain formation will eliminate themselves.

This method does not always work if the arm has been removed, but in the case of the lower limbs it has good results.

Prosthetics as a method of treating phantom pain

As for such a method of dealing with phantom pain as prosthetics, it also has good statistics.

The basis of this method is that after amputation of a limb, the need for movement remains, and the nervous system cannot realize it.

The old generation of prostheses cannot solve the problem of eliminating phantom pains, and scientists are developing the latest prostheses that work through nerve impulses transmitted through the patient's peripheral nervous system. Such prostheses fill the needs of the body and completely stop phantom pain.

At present, products for the upper limbs have been developed and work is underway on a device for the legs.

Folk remedies

There is little evidence of the use of folk remedies for phantom pain, and they all come down to recommendations regarding the patient's lifestyle. There is no magical herb that will remove all ailments like a hand, unfortunately, the nervous system has a rather complex structure and is not always treated with herbs.

• In the first days after removal, rest is shown (physical activity is contraindicated, as it can provoke pain);
• Tight bandages (the presence of a compressive bandage, even at night, does an excellent job with phantom pains);
• Massage (massage of a limb that has undergone surgical intervention, you can additionally influence it with tissues of various textures);
• Self-hypnosis (imagining that the removed limb is back in business, pedaling, knitting, etc. has a good effect, and regular repetition of this recommendation will reduce the intensity of the pain syndrome several times).

Phantom disease prevention

Phantom pain can be treated and sometimes effectively, but the best option is systematic preparation for removal and prevention.

So, a few days before the removal, the patient is injected with morphine or preparations based on it, in addition, in addition to general anesthesia, a blockade of nerve endings is performed, which reduces the risk of phantom pain after surgery.

So, phantom pain is a phenomenon that is difficult for the human brain to understand, which is difficult to deal with on its own. If you have such pain, do not torture yourself, contact a specialist.

Phantom pains appear in a remote limb or organ. It can be burning, shooting, tearing, penetrating pain, as well as itching, tingling and other sensations. The syndrome occurs regardless of the type of amputation - surgical or traumatic.

The disease is recognized as one of the most severe types of neuropathic pain syndrome. Sometimes imaginary "pain" can lead the patient to despair. Against the background of pathology, attempts to commit suicide often occur. Any slightest touch, even to a healthy limb, can provoke acute pain in the amputated.

It should be noted that the phantom disease is specific in that no analgesics, including narcotic ones, help the patient. The lack of adequate drug treatment often leads to the fact that patients consume large amounts of drugs that accumulate and, in combination, can cause toxic poisoning of the body.

The number of patients who suffer from phantom pain after limb removal is quite large. In the first days after amputation, pathology manifests itself in 72% of patients. After 6 months - 65%. After 5-10 years, they continue to complain about phantom sensations in a remote part of the body - about 60%.

Currently, there are a large number of different methods of treating phantom pain. There is also a chance that the pain will go away on its own with time. However, it is possible to completely get rid of pathological sensations, as a rule, in 15% of cases.

Phantom pains are characterized by the following main properties:

• The pain continues even after the complete regeneration of the damaged tissue. In some patients, the pain is transient, in others it persists for life.
• Trigger zones often spread to healthy areas on the same or opposite part of the body. A light touch on a healthy limb can provoke an attack of severe pain in the amputated.
• Long-term pain relief can be achieved by reducing somatic impulses. This is the basis of such methods of therapy as the introduction of anesthetics into sensitive areas of the stump. Such a blockade can stop pain for hours, days, and even forever. However, most often it is effective only for a few hours.
• Long-term pain relief may be due to increased sensory impulses. Injection of hypertonic solution into certain areas provokes pain that radiates to the phantom organ and lasts for several minutes. Subsequently, the pain partially or completely disappears for hours, days or forever. Relief can bring vibration stimulation, electrical stimulation of the muscles of the stump.

There is also the so-called "painless phantom". This phenomenon is based on the same developmental mechanisms as phantom disease. The patient immediately after the amputation feels the limb as if it had not been removed. According to the descriptions of sensations, the phantom organ has the same shape and characteristics as the healthy one. There is a feeling that the “imaginary” limb is in the same position as it would be in a real situation - in a prone position, sitting, on the move. The patient may also try to take an object with an amputated hand, get out of bed on the missing leg. Over time, the phantom organ may change shape and disappear.

The main causes of phantom disease

The mechanism of occurrence of pathology is not fully understood. According to the latest research in this area, it is believed that the cause of the development of phantom disease lies in the appearance of foci of pain activity in the cerebral cortex. They occur randomly and can be located at any level of the central nervous system.

When medical or surgical suppression of the focus of activity occurs at a specific level, pain begins to be generated in the overlying structures and the syndrome resumes with renewed vigor. In this case, it is even more difficult to treat it.

Since the structures of the brain that are responsible for the psycho-emotional state and regulation are involved in painful sensations, the pathology can also be accompanied by vivid emotional and mental abnormalities. The patient, in addition to physical sensations, is tormented by depression, panic, anxiety, hypochondria, fear. In addition, the central parts of the autonomic nervous system are involved, which provokes such disorders as heart palpitations, shortness of breath, suffocation, sweating, and abdominal pain.

In addition, at the level of the amputated part of the body, due to insufficient load on the musculoskeletal system, osteoporosis begins to develop, which is additionally responsible for pain "messages" from the periphery to the cerebral cortex. As a result, the pathological circle of self-sustaining phantom pain is closed.

In addition, there is an opinion that the development of phantom pain is promoted by neuromas - thickening and compaction at the ends of the cut nerves.

phantom disease symptoms

Phantom pains can be subtle and quite rare, and in some cases - permanent with a different character and intensity.

By nature, such phantom pains are distinguished:

1. Crumpy is a constricting and squeezing sensation.
2. Neuralgic - reminiscent of an electric shock.
3. Causalgic - the patient feels pain as something scorching.
4. Burning - heat that spreads over the amputated part of the body.

Pain can appear anywhere in the missing organ. As a rule, the same area hurts as before the amputation. For example, if the surgical removal of the leg was provoked by necrosis of the fingers, then after amputation, phantom pain will be localized there. Often, in order to provoke an intense phantom syndrome, it is enough to touch one or another part of the body. It will serve as a specific "trigger" for the phantom organ.

In addition, pain can be provoked by such factors:

• Impulses emanating from the organs in the process of urination and defecation;
• Pain in any other part of the body, diseases of the internal organs;
• Stress, anxiety, depression.

It should be distinguished from phantom pain sensations that are localized directly in the stump. In the first case, pathology is formed at the level of the central nervous system. In the second, pain is a consequence of processes occurring at the level of the peripheral nervous system. In the latter case, patients complain of aching, shooting, pressing, stabbing, throbbing pains. Moreover, such sensations do not occur immediately, but some time after the removal of the organ.

Features of the treatment of phantom disease

Treatment of this disease is a rather difficult process, which does not always bring good results. The most effective is an integrated approach to treatment - a combination of conservative, physiotherapeutic, psychotherapeutic methods. Also, in some cases, surgical treatment of phantom disease is indicated.

Quite often, phantom pain syndrome requires surgical intervention. As a rule, this is necessary in cases where the nerves of the stump were not treated during amputation, and also if the wound healed for a long time and suppuration occurred.

The essence of surgical intervention is an attempt to reduce phantom pain by interrupting pain impulses in different parts of the central and autonomic nervous system.

There are several methods of surgical treatment:

1. Sympathicotonia. The method consists in suppressing the sympathetic trunk of the autonomic nervous system.
2. Operations on the nuclei of the thalamus, which are subcortical formations of the brain.
3. Dissection of nerve endings and trunks at the site of the stump. This group includes reamputation, disarticulation, operations on large nerve trunks, cutaneous nerves, and on the posterior roots.

A wide range of surgical methods for the treatment of phantom disease indicates that it is extremely difficult to choose the optimal method of therapy. To do this, it is necessary to first conduct a thorough examination of the patient in order to find out which cutaneous or deep nerves are damaged or the occurrence of pain is associated with damage to blood vessels, bones, and tissues of the stump.

Only if the operation on the nerve endings or vessels turned out to be ineffective, the issue of preganglionic sympathectomy is decided.

Treatment of phantom disease with medications

When prescribing conservative treatment, analgesics are often prescribed. Sometimes the use of narcotic drugs is prescribed.

It is worth noting that injections into the stump area do not give any result. Temporary relief is brought only by blockades of sympathetic nerves. Persistent analgesic effect in the blockade of sensory nerves is achieved much less frequently. In medical practice, cases are even described when sensory blockade led to increased pain.

Most often, novocaine blockades are used. They can also be a diagnostic measure. Thus, infiltration of a scar area with a novocaine solution, which is located in the region of innervation of a certain cutaneous nerve, often leads to a decrease in phantom pain. This indicates that this nerve is involved in the pain syndrome.

Especially effective case blockade. But it is worth noting that the result of such treatment is unstable. Sometimes a pararenal blockade is prescribed, as well as an intravenous infusion of novocaine.

Treatment of phantom pain with physiotherapy procedures

The task of the physiotherapist is to reduce pain in the stump, eliminate the zone of pathological impulses, and increase blood flow to the muscles of the stump.

In case of exacerbations of the disease and phantom pains, a UHF electric field is used on the damaged area, CMV on the scar projection area, transverse fluctuorization method, scar franklinization, SMT on the skin of a sore spot, transcutaneous electrical stimulation, hydrocortisone (anesthesin) phonophoresis, short-wave ultraviolet irradiation in an erythemal dose, laser therapy for pain points.

In addition, various massage techniques for segmental sections of the spine, acupuncture, and vibrational massage of the hands are widespread.

After the pain is relieved, paraffin therapy, mud therapy, ozokerite therapy, warm baths based on local sea salt, as well as general baths - radon, iodine-bromine, coniferous - are prescribed. In addition, there are many innovative methods, for example, galvanotherapy, diadynamic therapy, SMT mud therapy for the stump area.

Psychotherapy for phantom pain

Psychotherapy can be effective when combined with tranquilizers and sedatives. There are many different methods of influencing the psyche of the patient.

One of the most popular innovative methods is “mirror therapy”. The essence of the method is a simple "deception" of the brain. A mirror box is put on the stump, which reflects a healthy limb. Thus, instead of a stump, the patient sees a mirror image, which the brain “perceives” not as a mutilation, but as a healthy organ.

You can aggravate the deception of the brain by moving the fingers of a healthy limb. Subsequently, patients should try to mentally finger the amputated organ.

In most cases, mirror therapy helps amputees.

Prosthetics as a method of treating phantom pain

Prosthetics can provide pain relief. This is due to the fact that after the loss of a limb, a large number of motor and sensory nerves remain. All of them, as before, give impulses to the cerebral cortex from the lost part of the body. This can lead to phantom pain.

Based on this knowledge, scientists develop innovative prostheses. Their main function is to help the patient feel everything that the prosthesis touches, so that he can control the artificial organ with the power of thought.

The new technique is called “guided muscle reinnervation.” For patients suffering from phantom disease, a bionic upper limb prosthesis has been created. Its activity is controlled by the nerve fibers of the hand. Currently, scientists are developing a similar lower limb prosthesis.

A device has also recently been patented that can be used to treat phantom pain. This is a device that is applied to the injured limb. Through it, a dosed stretching of the stump bone to the desired length for future prosthetics occurs. Thanks to this technique, the neuro-reflex connection, which provokes pain, is disrupted, the chronic pain syndrome is reoriented to the bone tissue of the organ. In addition, blood flow and metabolic processes in the stump area are improved. Thus, phantom pains are stopped.

Phantom disease prevention

To avoid the development of phantom disease, every effort must be made to prevent the formation of a painful stump. The main rules for this are:

• To prevent compression of the nerve endings in the scar, the trunks of the largest cutaneous nerves should be isolated and captured with special clamps during the formation of the skin flap.
• When crossing muscles, the same should be done in the intermuscular zones. Blood vessels pass through these places, and they need to be bandaged.
• It is necessary to provide the required length of muscle flaps in order to cover the bone sawdust with them. The latter must be processed aperiosteally with a sharp instrument.
• Hypodermic and main nerves should be cut high after their careful isolation from the fiber without sharp stretching. The latter can provoke fiber rupture and the formation of microneuromas, as well as distorted receptors.
• To prevent the formation of terminal neuromas, surgeons use a number of techniques: suturing the ends of the nerves into a higher section, wedge-shaped excision of the stump, using the epineurium to close the nerve section, cauterizing the end of the nerve with alcohol, carbolic acid, and electric current.
• The formation of an artificial "periphery" for the nerves. Axons of the nerve trunk can grow into it. For this purpose, a neurotomy is performed at a great distance from the place of amputation of the nerve with cauterization of the peripheral segment with alcohol and suturing the place of neurotomy.

Also, for the stump, it is necessary to choose the most comfortable position in which pain does not occur. You should remember this posture and stick to it. A light massage of the suture zone on the stump helps to relieve pain and prevent its occurrence. It can be alternated with rubbing the limb with a cloth of various textures and structures so that it can get used to the new tactile sensations.

If you practice yoga, then it makes sense to try one of the relaxation techniques. And you need to try to move a healthy limb, while imagining how the amputee moves.

What is a phantom disease - look at the video:

Before getting rid of phantom pains, it is necessary to consult with your doctor. Phantom disease is a rather serious pathology that should be treated comprehensively. Only with a combination of adequate therapeutic methods can a significant reduction in pain sensations or complete elimination of them be achieved.