phantom limb pain

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hello

i have a patient who had amputation of one leg about year and half ago. yesterday he complained of acute sharp pain of his amputated limb. is it possible to have phantom pain a year after amputation? i gave him pain pills but he still complained of pain. what does it indicate and what would you do?

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Specializes in Ortho, Case Management, blabla.

If he wasn't already on it, I'd consider recommending pregabalin, gabapentin, or carbamazepine to the physician. Has he been on those medications or antidepressants and recently stopped them during his hospitalization? I've also found that muscle relaxers like metaxalone or diazepam can help (depending on the mechanism causing the pain, there might be something else going on there). Unfortunately opiate type pain medications don't do much for phantom pain (at least in my experience). Unfortunately nursing interventions beyond relaxation and rest are pretty limited for phantom pain (it's not like you can elevate/ice the affected extremity..haha).

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phantom pain can last for years

i agree that the opiate pan meds don't bring much relief

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my father lost his leg in a motorcycle accident when he was 18 and he had phantom pain until he passed away at 87. It became not so much of a pain as the sensation that his leg was still there, I would suggest you educate your patient that this will become less severe and painful as time goes by but that he may always have sensations that his limb is still there.

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Specializes in Psychiatric.

Obligatory Wikipedia link:

http://en.wikipedia.org/wiki/Phantom_limb

Some novel treatments are mentioned toward the end.

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Phantom pain can be a lifetime thing. Remember that even though they don't have a limb there, that pain is (according to JCAHO) "whatever the pt says it is, occuring wherever and whenever the pt says it is occuring," which means it has to be treated,

I agree with the above poster; pregabalin and gabapentin seem to work very well for phanton limb pain.

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Specializes in trauma, ortho, burns, plastic surgery.

Yes is true. Phantom limb perception and pain in phantom limb are two different issues, strong interrelated. Is a loooooong long story about, and the actual medications only treat the symptomatogy of. Actual theories told us that phantom pain is based on altered neurological pathways and cortical reorganization. Loooong time ago Zuzi studied phantom limb and pain in phantom limb, I am soo tired now, but what I could tell you is that is not only one explanation in domain, too old and tired Zuzi now, and with others priorities, looooool. Pease if you want specifical details, make a search over the net and when you have very clear what is about, come to talk. With all my heart happy to help you! Always a Zuzi nurse here!

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Phantoms in the Brain by V.S. Ramachandran has a chapter or two on phantom limb pain. It's an interesting book.

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i have a patient who had amputation of one leg about year and half ago. yesterday he complained of acute sharp pain of his amputated limb. is it possible to have phantom pain a year after amputation? i gave him pain pills but he still complained of pain. what does it indicate and what would you do?

most patients with phantom pain have an onset within days of the initial amputation. although there have been some reports of pain starting months to years after the initial event, this is pretty rare.

depending on the type of amputation, activity level, fit of the prosthesis, actual location and character of the pain, and other comorbidities, other causes are more likely.

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i listened to a very interesting segment on notional puplic radio NPR. idea stream wcpn. a doctor, who's name i dont recall, cured his patient of his phantom pain by tricking the brain to think that the limb was back on the body by using a mirror. i know it sounds crazy to me too, but it may be worth looking into. try logging on to the stations web-site to find a recording of the segment, or the doctors contact info.

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Specializes in Psychiatric.
i listened to a very interesting segment on notional puplic radio NPR. idea stream wcpn. a doctor, who's name i dont recall, cured his patient of his phantom pain by tricking the brain to think that the limb was back on the body by using a mirror. i know it sounds crazy to me too, but it may be worth looking into.

Actually, that's the treatment I referred to that is mentioned at the end of the Wikipedia article I linked to. The tool used is called a Mirror Box:

http://en.wikipedia.org/wiki/Mirror_box

Apparently, the brain perceives the phantom limb as being stuck in an uncomfortable or painful position. By using the mirror box, one can trick the brain into feeling like the arm is moving out of the stuck position.

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Specializes in Ortho, Case Management, blabla.
Actually, that's the treatment I referred to that is mentioned at the end of the Wikipedia article I linked to. The tool used is called a Mirror Box:

http://en.wikipedia.org/wiki/Mirror_box

Apparently, the brain perceives the phantom limb as being stuck in an uncomfortable or painful position. By using the mirror box, one can trick the brain into feeling like the arm is moving out of the stuck position.

That's awesome!! I wonder if that would be a therapy that would fall under a nurse's scope of practice?

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