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Phantom Limb & Stump Pain

Weir Mitchell coined the term phantom-limb pain in 1872. It describes the pain in the body part that is no longer present, which occurs in 50–80% of all amputees. Pain can have several different qualities, such as stabbing, throbbing, burning, or cramping. It seems to be more intense in the distal portions of the phantom limb. This pain may be related to a certain position or movement of the phantom and may be elicited or exacerbated by a range of physical factors (e.g., changes in weather or pressure on the residual limb) and psychological factors (e.g., emotional stress).

It is more likely to occur if the individual had chronic pain before the amputation. Pain in the phantom is often similar to the pain felt in the limb before amputation. Phantom pain is most common after the amputation of an arm or leg, but it may also occur after the surgical removal of other body parts, such as breast, rectum, penis, testicle, eye, tongue, or teeth. About 30% of persons with amputation report the feeling of telescoping, i.e., the retraction of the phantom towards the residual limb and in many cases, the disappearance of the phantom into the limb. This may be accompanied by a shrinking of the limb. Recent evidence suggests that telescoping is associated with more phantom-limb pain.

Phantom-limb pain is commonly confused with pain in the area adjacent to the amputated body part. This pain is referred to as residual-limb or stump pain. Patients may report severe, knife stabbing or sharp pain in at the end of the amputated limb. Formation of neuroma or pressure-lesions of the stump may exacerbate the stump pain. Physical examination may reveal the existence of a neuroma. It is usually very sensitive to touch or pressure. However, stump pain may coexist with phantom limb pain.

Changes along the neuroaxis may contribute to the experience of phantom-limb pain. Spinal mechanisms are characterized by increased excitability of the dorsal-horn neurons, reduction of inhibitory processes, and structural changes at the central nerve endings of the primary sensory neurons, interneurons, and the projection neurons. Supraspinal changes related to phantom-limb pain involve the brainstem, the thalamus, and the cortex.

Reorganization of the somatosensory cortex of the human cerebral cortex in amputees has been supported by findings from several imaging studies. People with arm or hand amputations show a shift of the mouth into the hand representation in the primary somatosensory cortex. Studies in human amputees have shown that reorganizational changes also occur at the thalamic level and are closely related to the perception of phantom limbs and phantom-limb pain. Neuroma in the stump may be more responsible for stump pain than phantom limb pain.

However, abnormal input originated from a neuroma in the residual limb may increase the amount of central reorganization, enhancing the chance of phantom-limb pain. Psychological factors also play a role in the modulation of phantom-limb pain. Phantom-limb pain may also be exacerbated by stress. Patients who lack coping strategies, fear the worst, or receive less social support, tend to report more phantom-limb pain.

Treatment for phantom limb pain has been difficult. Although tricyclic antidepressants and sodium-channel blockers are treatments of choice for neuropathic pain, there have been no controlled studies of these agents for phantom-limb pain. Opioids, calcitonin, and ketamine have been proven to be effective in reducing phantom-limb pain in controlled studies. Transcutaneous nerve stimulation (TENS) may have a minor effect on phantom-limb pain. A maximum benefit of about 30% has been reported from treatments such as local anesthesia, sympathectomy, dorsal-root entry-zone lesions, cordotomy, rhizotomy, neurostimulation methods, or pharmacological interventions such as anticonvulsants, barbiturates, antidepressants, neuroleptics, and muscle relaxants. Use of a myoelectric prosthesis may alleviate cortical reorganization and phantom-limb pain. Deep brain stimulation also has been reported to treat phantom limb pain.

Meet the FLPNR Team

  • YiLi Zhou, M.D., Ph.D
  • Hoang (Wayne) T. Vu, D.O.
  • Lourdes Varela–Batista, M.D.
  • Vinh-Loc Nguyen, P.A.
  • Kirstie Nicol, P.A.
  • Irene Aponte Moreno, N.P.
  • Sunny Park, N.P.
Neurologist in Ocala, FL Doctor of Osteopathic Medicine in Ocala, FL Physician in Ocala, FL Physician in Ocala, FL Physician in Ocala, FL Nurse Practitioner in Ocala, FL Nurse Practitioner in Ocala, FL
Neurologist in Ocala, FL

YiLi Zhou, M.D., Ph.D.

Harvard-Trained, Board-Certified Pain Specialist and Neurologist.

Dr. Zhou graduated from Wenzhou Medical College, China in 1982 with training in both modern western medicine and traditional Chinese medicine. He had neurology fellowship training at Shanghai Medical School, specializing in EMG/NCV and evoked potential studies. He served as an attending neurologist in China.

Doctor of Osteopathic Medicine in Ocala, FL

Hoang (Wayne) T. Vu, D.O.

Dr. Zhou graduated from Wenzhou Medical College, China in 1982 with training in both modern western medicine and traditional Chinese medicine. He had neurology fellowship training at Shanghai Medical School, specializing in EMG/NCV and evoked potential studies. He served as an attending neurologist in China.

Physician in Ocala, FL

Lourdes Varela–Batista, M.D.

Dr. Varela is a fellowship trained pain specialist and board certified PMR expert. Her specialities include physical medicine and rehabilitation and interventional pain medicine. She received her undergraduate degree from University of Puerto Rico and completed her medical degree from New York Medica College. Dr. Varela completed her physical medicine and rehabilitation residency at University of Texas Health Science Center San Antonio.

Physician in Ocala, FL

Vinh-Loc Nguyen, P.A.

Vinh-Loc Nguyen is a NCCPA certified physician assistant and is licensed by the State of Florida Department of Health. He received his Bachelor of Science degree in microbiology and Bachelor of Arts Degree in economics from University of Florida in 1994. He had a successful career in the financial industry before returning to his true passion for medicine.

Physician in Ocala, FL

Kirstie Nicol, P.A.

Kirstie has been serving as a physician assistant at Florida Pain and Rehabilitation Center, Lake City since September 2016. She is board certified by the National Commission on Certification of Physician Assistants (NCCPA). She received her master of science in physician assistant studies, at Clarkson University in Potsdam, NY.

Nurse Practitioner in Ocala, FL

Irene Aponte Moreno, N.P.

Ms. Irene Aponte Moreno is an Adult-Gerontology certified Nurse Practitioner and licensed by the State of Florida Department of Health. In 2014, she received her Master of Science degree in Nursing from the University of South Alabama. She completed her Bachelor of Science degree in Nursing from Jacksonville State University in December of 2006. In 2003, she received an Associates of Arts degree from Southwestern Michigan College. She also completed an Associate degree in Informatics from the University Institute Antonio Jose de Sucre located in Lara State, Venezuela.

Nurse Practitioner in Ocala, FL

Sunny Park, N.P.

Ms. Sunny Park is an AANP and ANCC certified Advanced Registered Nurse Practitioner, licensed by the State of Florida Department of Health. She graduated with Summa Cum Laude with Bachelor of Arts in Drawing from Southern Illinois University in 1999. She pursued nursing career and graduated with Associate of Science in Nursing in 2007 and started working as a registered nurse in Cardiovascular ICU in St.Luke’s Medical Center. She continued with her education and graduated with Magna Cum Laude obtaining Bachelor of Science in Nursing in 2010 from Cardinal Stritch University. During her nursing education, she was awarded multiple scholarships including the Lamplight scholarship by Milwaukee Nurses Association.

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