Phantom pain: a therapeutic challenge

Following the amputation of a limb or a part of it, the patient may experience sensations, illusions that the limb is still there. Such symptoms are referred to as phantom experiences. Directly after an amputation these symptoms are present in the majority of patients (in up to 97% of cases). With time, the sensory experiences and pain disappear and most patients develop a sensation that the amputated limb is shrinking and, as with a telescope, getting closer to the stump. Two years after the amputation and when the wound has completely healed, chronic and generally refractory pain affects only 2–4% of these patients. This pain is referred to as phantom pain. Both phantom experiences and phantom pain may also develop after the surgical amputation of other parts of the body, for instance after amputation of a breast. In some patients phantom pain may resolve after many years but quite often recurs. Its severity varies from the barely perceptible to the very troublesome, limiting a patient’s activity. The management of phantom pain is a considerable challenge, not only for doctors but also for the entire team providing comprehensive therapy (such as physical therapists and psychologists). Knowledge of the pathomechanisms of phantom pain and an understanding of the principles of and the need for a multidirectional approach determine the optimal treatment for a patient suffering from this kind of pain. Adv. Pall. Med. 2010; 9, 1: 21–28Following the amputation of a limb or a part of it, the patient may experience sensations, illusions that the limb is still there. Such symptoms are referred to as phantom experiences. Directly after an amputation these symptoms are present in the majority of patients (in up to 97% of cases). With time, the sensory experiences and pain disappear and most patients develop a sensation that the amputated limb is shrinking and, as with a telescope, getting closer to the stump. Two years after the amputation and when the wound has completely healed, chronic and generally refractory pain affects only 2–4% of these patients. This pain is referred to as phantom pain. Both phantom experiences and phantom pain may also develop after the surgical amputation of other parts of the body, for instance after amputation of a breast. In some patients phantom pain may resolve after many years but quite often recurs. Its severity varies from the barely perceptible to the very troublesome, limiting a patient’s activity. The management of phantom pain is a considerable challenge, not only for doctors but also for the entire team providing comprehensive therapy (such as physical therapists and psychologists). Knowledge of the pathomechanisms of phantom pain and an understanding of the principles of and the need for a multidirectional approach determine the optimal treatment for a patient suffering from this kind of pain. Adv. Pall. Med. 2010; 9, 1: 21–2