Therapy
To date, there is no uniform therapy for phantom pain. Since it has been shown that patients with adequate prosthesis fitting had the least brain reorganisation and were least affected by phantom pain, those affected should receive a prosthesis as far as possible. In most cases, drug treatment is attempted first.
Since phantom pain is classified as so-called neuropathic pain, i.e. pain whose cause lies in the nerve itself, coanalgesics play an important role here. These are drugs that were not originally intended as painkillers, but which have been shown to be very effective in treating this type of pain. These include mainly drugs from the antidepressant and anti-epileptic groups.
Since phantom pain originates in the brain, many sufferers benefit from drugs that act in the central nervous system, such as opiates and NMDA receptor antagonists. If the phantom pain persists despite drug therapy, special pain therapy should be provided. Here, treatment by experienced pain specialists is recommended.
Multimodal pain therapy, in which at least two different medical disciplines are involved, often leads to success. For example, physical therapies or transcutaneous electrical nerve stimulation (TENS) are used. Relaxation methods and behavioral therapy can also contribute to improvement.
There are also procedures that attempt to reverse the reorganization that has taken place in the brain. There are various options available for this: Myoelectric prostheses are modern prostheses that can partially restore the function of the lost body part. Regular wearing of the prosthesis also leads to activation of the brain region that was altered by the amputation.
Within the framework of mirror therapy, the patient sits in such a way that he or she can see his or her healthy limb in the mirror. If he moves it, the brain interprets this as movement of the amputated limb, which can contribute to an improvement in phantom pain. Various exercises such as visualizing imagination exercises and stimulation of the remaining residual limb can also have a pain-relieving effect.
Other treatment options include acupuncture, spinal cord stimulation, deep brain stimulation or the administration of injections of local anesthetics or corticoids into the remaining residual limb. It is important that there is not only one way to treat phantom pain. Each patient should find his or her own individual therapy. Often this is not easy and requires trying out different drugs and methods. In the end, a combination of different drugs and methods often effectively relieves the pain.
