إن ذاك الألم الذي يشعر به من فقد أحد أطرافه يسمى بالألم الشبحي فماهي أسبابه و ما علاجه ؟

التهاب الصفاق الأخمصي Planter fasciitis ألم عقب القدم شكوى الأنسجة

Phantom Pain is due to the pain we feel in the amputated (lost) limb. It may be an amputation due to an accident or an amputation due to a harmful disease such as gangrene (gas gangrene), and it may be felt after the removal of the breast or one of the viscera. It varies from person to person. The patient may feel a sensation in the amputated limb, but it may not be painful. As for the stump pain, it is the pain that the patient feels in the residual part of the amputated limb (stump). Patients with amputation often feel these pains at the same time. In fact, about three-quarters of patients with amputation have a phantom sensation. Most of them experience this pain in the first few days after amputation. It may appear months or even years after amputation. The pain may last for several years, but it may improve over time. This pain usually comes in bursts. A few patients have persistent pain. Some people experience several attacks per day, while others experience fewer than one attack per week. Phantom pain is often described as a stabbing, burning, or gunshot-like pain. The patient often feels it at the end of the amputated limb in the fingers or amputated toes.

Amputations are typically carried out on the leg to alleviate pain resulting from poor blood circulation to the limb. This is often caused by peripheral arterial disease, which is more common in smokers and can lead to gangrene. In such cases, amputation is necessary to prevent further spread of the gangrene. Traumatic amputations are usually caused by injuries sustained in road accidents or during wars and may also affect the nerves.

Causes of amputations:

The exact cause of phantom pain is not yet fully understood. It is believed that nerve damage during amputation can cause changes in the nervous system, which in turn can lead to alterations in the way the brain processes messages from the body. The parts of the brain that are responsible for controlling the missing limb continue to remain active, leading to the sensation of a phantom limb. Even though the person knows that the limb is not there, the brain is tricked into believing that the sensations are real, resulting in the experience of phantom pain.

Treating phantom pain:

Treating phantom pain can be challenging. It’s important for the patient to discuss their symptoms with their doctor to have a referral to a pain or physical therapy clinic if necessary.

Medications: Phantom pain is a challenging condition to treat.

• Over-the-counter painkillers like Paracetamol and Ibuprofen can provide some relief, but their effect is mild.
• Amitriptyline, an antidepressant, can also help alleviate phantom pain. However, it may cause side effects such as dry mouth, drowsiness, constipation, or nausea, which can be challenging to manage. Thus, physicians must balance the side effects with the desired effects to provide the best possible care to their patients.
• Carbamazepine, marketed under the brand name Tegretol, is an anticonvulsant medication that is mainly used to treat epilepsy. It is also effective in relieving nerve pain. Other anticonvulsants such as Lamotrigine (Lamictal), Gabapentin, and Pregabalin (Lyrica) can also provide relief from epilepsy and nerve pain, either alone or in combination with other medications. These medicines should be taken regularly to be effective, rather than only when needed. It is possible that more than one medicine may be needed to manage the condition.
• However, these medications may also have side effects, such as feeling tired, drowsy, or agitated. In some cases, the doctor may need to use strong painkillers such as morphine.
• Alternatively, Tramadol, which is a slightly milder drug than morphine, may be used.
• Pharmaceuticals intended for treating other neurological disorders like depression and epilepsy have been found to be effective in alleviating nerve pain that results from specific neurological impairments.

Electrical stimulation

• Transcutaneous electrical stimulation (TENS) may help well in many patients. Stimulating electrodes are placed on the stump, which gives a tingling sensation and reduces pain. Other types of analgesic currents can also be applied in physical therapy.

Fitting the prosthetic limb and rehabilitation: Phantom pain can be relieved by using the prosthesis effectively. Using the limb with the prosthesis as much as possible helps relieve pain.

Good rehabilitation is one of the successful ways to reduce the amount of pain.

Alternative treatments such as vibration therapy, acupuncture, hypnosis, and biofeedback can sometimes be used to relieve phantom pain, and their effects are usually mild. One effective way to alleviate pain is by distracting the patient and redirecting their attention. In some cases, a gentle massage of the affected area can also provide relief.

Another useful method is to accustom the limb to touch and contact with things, as the fear of touch can develop in the patient to become a feeling of fear of any movement or touch on the limb.

Psychotherapy

Patients experiencing phantom pain may also encounter depression. It is highly recommended to seek assistance from general psychological support and pain management programs for effective treatment. You can avail scientific and psychological support by consulting physiatrists or neurologists in physical therapy clinics.

If you or someone you know is suffering from phantom pain, do not hesitate to consult a rehabilitation doctor or neurologist. They can help you find a way to alleviate the pain you are experiencing.

Dr. Fayez Fathi Orabi

Consultant in physical medicine and rehabilitation