how to treat phantom pain?

A person can have a leg amputated and feel the missing limb. This phenomenon i phantom membercalled hallucinosis, affects two-thirds of patients who have had amputations,, says Dr. Fabien Zagnoli, neurologist, former associate professor at Val-de-Grâce. It’s all in the head: Our brain has an accurate representation of all parts of our body. When a limb is removed, it doesn’t snap back immediately: it needs time to reorganize. This strange feeling is rarely annoying.

The real problem is phantom pain, or algohallucinosis, which affects the limb that no longer exists. It results in constant or intermittent tingling, burning, electric shock or compression: These are very real neuropathic pains associated with disorganization of the central nervous system. Do not confuse them with trunk pain, due to the section of the nerve fibers, which can lead to the formation of a growth called a neuroma, an infection or difficulty fitting the prosthesis. The answer is local (surgery, prosthetic modification, etc.).

Multidisciplinary approach

In algohallucinosis, management is multimodal. Drug treatments are based on antidepressants or antiepileptics, which block pain by acting on the central nervous system. In the acute stages, anesthetics (ketamine) may be prescribed. Common analgesics have little or no effectiveness, says the neurologist. Regarding non-drug therapy, when the origin of the pain is peripheral, transcutaneous electrical nerve stimulation (TENS), with electrodes placed on the trunk, can be used.

When the origin is central, treatment often includes cognitive rehabilitation therapy, via mirror therapy or immersive 3D virtual reality: The idea is to trick the brain, using a mirror or software that gives patients the impression of seeing the missing limb move. This perception allows a reconstruction of the brain.

For more stubborn pain, this may go as far as implanting electrodes into the spinal cord or brain. In addition, occupational therapy, physiotherapy, acupuncture or hypnosis may help or provide relief. Common after an amputation, phantom pain affects a third of patients long-term.

“I may be resistant to pain, but I cried”

Alain Vidal, 66, double femur amputee since October 2012, vice president of“Association for the Protection and Study of Amputees, testifies to his experience:I became aware of phantom pains when I came out of a coma, three months after my double amputation. Both feet touch me, but not at the same time. On the other hand, in both cases I feel very strong electric shocks and the trunk becomes paralyzed. These pains occur, when the crisis is there, every minute. I had seizures that lasted twenty-four hours.

A double femur amputee since October 2012, Alain Vidal is vice president of the Association for the Protection and Study of Amputees. | Dr.

I may be resistant to pain, but I cried. Also, it does not warn. In this case, I lie down and try to find a favorable position. As I am a double amputee, I could not use mirror therapy, which returns an image of the entire limb instead of the missing one. So I took medication, but for five years, I only take anti-depressants, I stopped the anti-epileptics, because of the side effects, including drowsiness. I prefer my autonomy and in particular the ability to drive.

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