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More about Phantom Limb
GIVEN the progress that medical science has made in the past few decades, new treatment options are now available for diseases that were previously thought to be incurable. However, there are various other medical problems which have emerged as a side-effect to these medical treatments. In this context, Phantom Limb is a treatment option available to those who have undergone amputation.
Phantom Limb pain
Phantom Limb is a syndrome experienced mostly by an amputated patient. It is the pain which a person feels when his/her limbs are removed. The pain is usually continuous, stern and disabling, and is considered to be untreatable. Usually two-third of all amputees experiences this pain for eight years after amputation. The duration and intensity of pain may vary in different individuals in terms of years of experience. The phenomenon of Phantom Limb is also present in children who have been born without a limb and this has helped scientists understand the role of the brain in perceiving sensations of pain from parts of the body which have been amputated or are congenitally absent. The type of pain which is experienced is mostly said to be burning, aching and excruciating and the reasons for this pain can differ. For example, any damage to nerve endings which may result in their regeneration gives abnormal and painful discharge of the nerves emerging from or leading to the brain or spinal cord.
There are also researches showing the role of changed nervous system performance within the brain as a result of loss of sensory input from amputated limbs giving out sensations of pain. Phantom Limb pain is generally intractable and chronic, as when it develops, it lingers and doesn’t show signs of getting better. The present treatment options are only available through medicine or surgical means as the pain reoccurs with any treatment applied. The phenomenon of Phantom Limb helps in understanding the working of the brain which has an image of all body parts inside it. The brain continuously updates itself with respect to the body parts, according to the sensory input it receives.
Studies have shown that the cortical reorganisation takes place after amputations. Significant association has been found between the intensity of Phantom Limb pain and the type of cortical reorganisation. The studies done with the help of Magnetoencephalography showed that areas of the brain which represent the hands and lower limbs get activated whenever the lower or upper face was touched. That also explains why pain is also felt even in the absence of limbs.
Treatment
There has been lot of research going on for the treatment of Phantom Limb pain, some of which are potentially important treatment options. Some scientific researches have shown that the development of Phantom Limb pain is associated with changes in the perception of the peripheral areas of the body by the sensory cortex. The first treatment option is the use of an electrical prosthetic limb which is moved by signals from the muscles of the patient which helps to reduce pain if worn for several hours per day. Investigations of the brain have shown that this effect is related to a reversion of the sensory cortex to its original state. Phantom Limb pain can also be decreased by repeated touching of the skin over the stump which improves sensory differentiation of the brain and helps in changing some of the sensory input to the brain which has been already lost due to amputation. Another treatment option has been discovered with the help of scientific results which show that the stimulation of the motor cortex — the area controlling movements of the body — can decrease Phantom Limb pain for some time. An interesting treatment plan was designed by neuroscientists Ramachandran and Rogers-Ramachandran in 1996. They developed a mechanism in which people with amputations of the arm and Phantom Limb pain would place their arms inside a mirror box so that they could see their good arm in the mirror. However, the reflection was reversed so that the intact limb would look like their amputated one. When they moved their good arm in the box, it made them think they were moving their amputated limb and helped them to psychologically control their pain.
Phantom Limb pain which is associated with any sort of damage to the peripheral nerve has shown that instructing patients to imagine their paralysed arms moving in relation to a moving arm on a screen in front of them can also reduce phantom pain. According to scientists, the trials to connect visual and motor systems of the brain might be helpful for patients in order to regenerate a rational image of the body in the brain. This can help in reducing pain by decreasing input from the amputated area. This treatment plan has given a new direction to treatment options, using a simple and easy means of fighting pain. There are also experiments being performed for constructing an arm in virtual reality which can be used by patients so that they can move themselves with the help of motion capture techniques. These movements can be traced by a movement tracing device and can also be projected in virtual reality. Scientists believe this will enable patients to have a sense of re-embodiment in the virtual arm which will ultimately decrease the sensation of pain. Most treatment options are based on the basic shift with emphasis on Phantom Limb pain away from the site of painful limbs to the centre of pain processing area in the brain. It has been shown that altered signals from the limb’s sensory systems along with the disturbed motor output to the limbs produce disparity between the brains’s built-in map of the physical body and the perception of brain. It is believed that this mismatch may result in pain.
It is expected that these simple treatment techniques will be helpful in decreasing pain in patients suffering from Phantom Limb pain for many years.
The writer is a freelance contributor
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