Phantom pain

introduction

The feeling of Pain in a part of the body that is no longer there often after the loss of a body part, usually as part of a amputation, occurs. Mostly it comes after removal of Divide the extremities to phantom pain, in principle, however, they can occur everywherewhere an amputation is carried out, for example after one Breast removal.

root cause

For a long time it was assumed that those affected were the Imagine phantom pain, later it was suggested that Changes to the remaining stump would create this pain. It is now known, however, that phantom pain in the brain by a faulty activation of the pain system arises. Accordingly, phantom pain can be understood as a kind of nerve pain.

The basis of the sensation of pain is that the Pain stimulus passed on, from Brain processes and finally rated becomes. This is also a reason for having different stimuli subjectively as differently painful be assessed.
On the one hand, the so-called plays in the development of phantom pain "Projected pain" a role: a Nerve cord is assigned to a certain supply area, so that the brain knows when there is an impulse via this nerve where the stimulus comes from. However, this system can be fooled if, for example, one looks at the Elbow strikes, you often feel a Tingling in the little finger. Therefore, the brain “projects” this pain onto the little finger.
On the other hand, it comes from the severe painthat occurs during and after the loss of a body part Changes in the brain. Of the sensorimotor cortex is the area of ​​the brain that is responsible for the Processing and evaluation of sensations, so is also responsible for pain. Each body region is represented there, the size of the respective area depends on the amount of sensations coming from there. After losing a body part, that body part is further mapped in the sensorimotor cortex. However, there is a reorganization of this brain region: the brain region assigned to the removed body part gets no more impulses from its traditional part, but the area is increasing activated from neighboring areas. The stronger this reorganization, the stronger the perceived phantom pain.

Another factor influencing the strength of phantom pain is that Pain intensity before amputation of the body part. Negative sensations, such as severe pain, are generated by the brain in the "Pain memory" stored, there are changes in the brain and the brain can recall this pain later. This can also happen if the actual cause of pain no longer is there, for example after an amputation. It can then happen that the body's own pain-relieving mechanisms are no longer active, but precisely that in the brain felt previous pain becomes.

diagnosis

When pain occurs after amputation, the accurate recording of the medical history and the exact description of the pain of great importance to the patient. A distinction must be made between phantom pain Stump pain, i.e. the pain in the remaining stump of the removed body part. These can for example by Inflammation, bruising, nerve injuries, or poor circulation arise. The victim should die exact place and describe the type, severity and duration of the pain. In addition, it should be noted whether the pain can be triggered or alleviated by certain factors. Since this can be difficult for the person concerned, it can be after an amputation Keeping a pain diary be useful.

Frequency distribution

The Frequency of phantom pain varies, depending on the studies, between extremely rare and almost after every amputation. Mean values ​​are in a range between 50 and 75%, therefore it can be assumed that phantom pain is a common problem after amputations is and at more than half of the amputees occurs.
A distinction must be made between the so-called Phantom sensations, non-painful feelings in the amputated part of the body, which is felt by almost every person affected after experiencing an amputation.

Phantom pain is most common the closer to the trunk (more proximal) the amputation took place. If phantom pain occurs, it usually already begins in the first month after the amputation, but in more than half it holds even over a year on. In less than 10% of those affected, phantom pain occurs for the first time after the first year after the amputation.

Symptoms

Usually a relatively short time after the loss of the body part, more rarely only months to years after the event, pain occurs in the body part that is no longer there. The pain is often called burning, stabbing, shooting or boring described and is mostly stronger at night than during the day. Phantom pain can be classified as recurring pain attacks or less than persistent pain occur. Often the pain is similar to the pain felt before the loss of the body part.
In many cases you can various factors affect phantom pain. This can be external factors like Heat or cold but also internal factors such as Stress, anxiety and general wellbeing can have an impact on phantom pain.

therapy

A uniform therapy of phantom pain does not exist to this day.

Since it has been shown that in patients with adequate prosthesis supply, who had the least reorganization of the brain and were least affected by phantom pain, should, whenever possible, have a Received prosthesis.
Most of the time, a medication tries. Since phantom pain is assigned to so-called neuropathic pain, i.e. pain whose cause lies in the nerve itself, the Coanalgesics important meaning too. These are drugs that not originally intended as a pain reliever where it turned out that they can help very well with this type of pain. These include mainly drugs from the group of Antidepressants and anti-epileptic drugs. Since phantom pain arises in the brain, many sufferers benefit from drugs that are im central nervous system work, these are for example Opiates and NMDA receptor antagonists.
If the phantom pain persists despite drug therapy, one should special pain therapy respectively. Here, the treatment is recommended experienced pain specialists, often leads the multimodal pain therapy, in which at least two different medical specialties are involved, to success. Be used, for example physical therapies or the transcutaneous electrical nerve stimulation (TENS). Also Relaxation procedures and behavior therapy can help improve.
There are also procedures that try that in the brain resulting reorganization reversed close. Various options are available for this: Myoelectric prostheses are modern prostheses that can partially restore the function of the lost body part. The regular wearing of the prosthesis also activates the region of the brain that has been modified by the amputation. As part of a Mirror therapy the person concerned sits so that he is in the mirror see healthy limbs can. If he moves it, this is interpreted by the brain as a movement of the amputated limb, which leads to a Improvement in phantom pain can contribute. Also different exercises like visualizing imagination exercises and Stimulation of the remaining stump can relieve pain.
Other treatment options are acupuncture, Spinal cord stimulation, deep brain stimulation or the administration of injections locally acting narcotics or corticosteroids in the remaining stump. What is important is that there is not just one way to treat phantom pain. Every patient should have his individually correct therapy being found. Often this is not easy and requires it Trying out different drugs and methodsIn the end, a combination of different drugs and methods often effectively relieves the pain.

prophylaxis

A key factor in the development of phantom pain is Strength and duration of pain before removing the body part. Hence it is an optimal one Pain therapy before an amputation the central approach to preventing phantom pain. This is the only way she can Prevents the formation of a pain memory become.
Also after the operation consistent pain therapy should take place. In addition, painful stimuli can occur during the operation spinal cord anesthesia procedures be reduced.

forecast

The prognosis of phantom pain depends primarily on one earliest possible start of therapy from. For optimal pain therapy in the first few weeks, 70-90% of those affected reported good therapeutic success. If pain therapy begins with a delay, this is the case for only about a third.
A prediction of the persistence of phantom pain is generally not possible. Spontaneous suspension is possible, as is the return of pain after pain relief. Pain that persists for a period longer than six months is to be regarded as unfavorable prognostically.