phantom limb pain
The appendage may be gone, but the pain it once had lives on. Phantom Limb Pain (PLP) refers to painful and lasting sensations that seem to be radiating from a limb, extremity, or other body part, that is no longer connected to the body. The suffering that PLP causes isn’t uncommon, either: between 60-80% of all amputees experience some kind of phantom sensation in a lost limb.
To date, there is no reliable treatment for Phantom Limb Pain, a condition affecting 1.7 million people in the US and 10 million people world-wide.
The Olvis Foundation is actively involved in the development of a new, breakthrough device that has completely eliminated PLP events in 80% of patients tested. We call it PEB (Phantom Pain Event Blocker) PEB is a non-invasive wearable that is comfortable enough to sleep in. This offers PLP sufferers the greatest opportunity for relief, since modern research and patient testimony documents most PLP events take place while patients are resting. (not wearing a prosthetic device) PEB is also a portable device that can operate on flexible battery power for up to 6 hours. The battery automatically recharges when the device is connected to direct current via a micro-USB to AC adapter... the same device you use to charge your cell phone. PEB is a micro-processor driven smart device that can be reprogrammed and updated via the internet. In many cases, this will eliminate costly additional doctor visits and device replacement. Recent clinical trials have indicated that long term use of this device interrupts event patterns in patients who suffer scheduled (daily) Phantom Limb Pain Events. This new information makes a cure for PLP a real possibility for the first time in history.
The Olvis Foundation is actively seeking grant funding and business partnerships in order to bring this affordable device to the marketplace and make it available to amputees worldwide.
To date, there is no reliable treatment for Phantom Limb Pain, a condition affecting 1.7 million people in the US and 10 million people world-wide.
The Olvis Foundation is actively involved in the development of a new, breakthrough device that has completely eliminated PLP events in 80% of patients tested. We call it PEB (Phantom Pain Event Blocker) PEB is a non-invasive wearable that is comfortable enough to sleep in. This offers PLP sufferers the greatest opportunity for relief, since modern research and patient testimony documents most PLP events take place while patients are resting. (not wearing a prosthetic device) PEB is also a portable device that can operate on flexible battery power for up to 6 hours. The battery automatically recharges when the device is connected to direct current via a micro-USB to AC adapter... the same device you use to charge your cell phone. PEB is a micro-processor driven smart device that can be reprogrammed and updated via the internet. In many cases, this will eliminate costly additional doctor visits and device replacement. Recent clinical trials have indicated that long term use of this device interrupts event patterns in patients who suffer scheduled (daily) Phantom Limb Pain Events. This new information makes a cure for PLP a real possibility for the first time in history.
The Olvis Foundation is actively seeking grant funding and business partnerships in order to bring this affordable device to the marketplace and make it available to amputees worldwide.
Phantom limb Pain in modern history
Until recently, the dominant theory for cause of phantom limbs was irritation in the severed nerve endings (called “neuromas”). When a limb is amputated, many severed nerve endings are terminated at the remaining stump. These nerve endings can become inflamed, and were thought to send anomalous signals to the brain. These signals, being functionally nonsense, were thought to be interpreted by the brain as pain.
Treatments based on this theory were generally failures. In extreme cases, surgeons would perform a second amputation, shortening the stump, with the hope of removing the inflamed nerve endings and causing temporary relief from the phantom pain. But instead, the patients’ phantom pains increased, and many were left with the sensation of both the original phantom limb, as well as a new phantom stump, with a pain all its own . In some cases, surgeons even cut the sensory nerves leading into the spinal cord or in extreme cases, even removed the part of the thalamus that receives sensory signals from the body.
In the early 1990s, Tim Pons, at the National Institutes of Health (NIH), showed that the brain can reorganize if sensory input is cut off. Tamar Makin, a neuroscientist at Oxford University, followed up this lead Using functional magnetic resonance imaging (fMRI), which measures changes in blood flow due to brain activity, Makin's team scanned the brains of hand amputees, two-armed individuals, and people born with only one hand. As the participants were being scanned, they were told to move their hands, arms, feet or lips. Amputees with phantom pain were told to perform the movements with their phantom limb, whereas amputees with no phantom pain and those born without a hand were told to simply imagine moving their hand or arm.
The scans showed that amputees with phantom pain had the same pattern of brain activity as individuals with both hands. This was a huge surprise, Makin said. "If we take an individual who suffers from phantom pain, his brain would be indistinguishable from your brain." In addition, the phantom pain was linked to disrupted activity between different parts of the sensorimotor cortex, the part of the brain that processes touch and movement.
According to Makin, the problem, is the study shows that pain and remapping are correlated, but does not show that one causes the other.
Nevertheless, the study "confirms the idea that we might be able to treat phantom limb pain by treating that brain-map,"
Treatments based on this theory were generally failures. In extreme cases, surgeons would perform a second amputation, shortening the stump, with the hope of removing the inflamed nerve endings and causing temporary relief from the phantom pain. But instead, the patients’ phantom pains increased, and many were left with the sensation of both the original phantom limb, as well as a new phantom stump, with a pain all its own . In some cases, surgeons even cut the sensory nerves leading into the spinal cord or in extreme cases, even removed the part of the thalamus that receives sensory signals from the body.
In the early 1990s, Tim Pons, at the National Institutes of Health (NIH), showed that the brain can reorganize if sensory input is cut off. Tamar Makin, a neuroscientist at Oxford University, followed up this lead Using functional magnetic resonance imaging (fMRI), which measures changes in blood flow due to brain activity, Makin's team scanned the brains of hand amputees, two-armed individuals, and people born with only one hand. As the participants were being scanned, they were told to move their hands, arms, feet or lips. Amputees with phantom pain were told to perform the movements with their phantom limb, whereas amputees with no phantom pain and those born without a hand were told to simply imagine moving their hand or arm.
The scans showed that amputees with phantom pain had the same pattern of brain activity as individuals with both hands. This was a huge surprise, Makin said. "If we take an individual who suffers from phantom pain, his brain would be indistinguishable from your brain." In addition, the phantom pain was linked to disrupted activity between different parts of the sensorimotor cortex, the part of the brain that processes touch and movement.
According to Makin, the problem, is the study shows that pain and remapping are correlated, but does not show that one causes the other.
Nevertheless, the study "confirms the idea that we might be able to treat phantom limb pain by treating that brain-map,"
Current Treatments
Finding a treatment to relieve your phantom pain can be difficult. Doctors usually begin with medications and then may add noninvasive therapies, such as acupuncture or transcutaneous electrical nerve stimulation (TENS).
More-invasive options include injections or implanted devices. Surgery is done only as a last resort.
Medications
Although no medications specifically for phantom pain exist, some drugs designed to treat other conditions have been helpful in relieving nerve pain. No single drug works for everyone, and not everyone benefits from medications. You may need to try different medications to find one that works for you. Medications used in the treatment of phantom pain include:
Possible side effects include sleepiness, dry mouth, blurred vision, weight gain, and a decrease in sexual performance or desire.
Noninvasive therapies
As with medications, treating phantom pain with noninvasive therapies is a matter of trial and observation. The following techniques may relieve phantom pain:
Minimally invasive therapies
Surgery may be an option if other treatments haven't helped. Surgical options include:
More-invasive options include injections or implanted devices. Surgery is done only as a last resort.
Medications
Although no medications specifically for phantom pain exist, some drugs designed to treat other conditions have been helpful in relieving nerve pain. No single drug works for everyone, and not everyone benefits from medications. You may need to try different medications to find one that works for you. Medications used in the treatment of phantom pain include:
- Antidepressants. Tricyclic antidepressants may relieve the pain caused by damaged nerves. Examples include amitriptyline, nortriptyline (Pamelor) and tramadol (Conzip, Ultram).
Possible side effects include sleepiness, dry mouth, blurred vision, weight gain, and a decrease in sexual performance or desire.
- Anticonvulsants. Epilepsy drugs — such as gabapentin (Gralise, Neurontin), pregabalin (Lyrica) and carbamazepine (Carbatrol, Epitol, Tegretol) — are often used to treat nerve pain. They work by quieting damaged nerves to slow or prevent uncontrolled pain signals.
- Narcotics. Opioid medications, such as codeine and morphine, may be an option for some people. Taken in appropriate doses under your doctor's direction, they may help control phantom pain.
- N-methyl-d-aspartate (NMDA) receptor antagonists. This class of anesthetics works by binding to the NMDA receptors on the brain's nerve cells and blocking the activity of glutamate, a protein that plays a large role in relaying nerve signals.
Noninvasive therapies
As with medications, treating phantom pain with noninvasive therapies is a matter of trial and observation. The following techniques may relieve phantom pain:
- Nerve stimulation. In a procedure called transcutaneous electrical nerve stimulation (TENS), a device sends a weak electrical current via adhesive patches on the skin near the area of pain. This may interrupt or mask pain signals, preventing them from reaching your brain.
- Mirror box. This device contains mirrors that make it look like an amputated limb exists. The mirror box has two openings — one for the intact limb and one for the stump.
- Acupuncture. The National Institutes of Health has found that acupuncture can be an effective treatment for some types of chronic pain. In acupuncture, the practitioner inserts extremely fine, sterilized stainless steel needles into the skin at specific points on the body.
Minimally invasive therapies
- Injection. Sometimes injecting pain-killing medications — local anesthetics, steroids or both — into the stump can provide relief of phantom limb pain.
- Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord can sometimes relieve pain.
- Nerve blocks. This method uses medications that interrupt pain messages between the brain and the site of the phantom pain.
Surgery may be an option if other treatments haven't helped. Surgical options include:
- Brain stimulation. Deep brain stimulation and motor cortex stimulation are similar to spinal cord stimulation except that the current is delivered within the brain. A surgeon uses a magnetic resonance imaging (MRI) scan to position the electrodes correctly.
- Stump revision or neurectomy. If phantom pain is triggered by nerve irritation in the stump, surgical resection or revision can sometimes be helpful. But cutting nerves also carries the risk of making the pain worse.