If your hand is gone, why is it still experiencing pain?
The short answer is because your hand never experienced pain in the first place. While our tissues have sensory receptors, all pain is actually “felt” in the brain, sent there by nerves communicating with the receptors. After a traumatic injury and amputation, nerves can be jumbled, and it can be easy for signals to get crossed and the sensation of pain to be “felt” in a finger, hand or arm that is no longer with you.
In addition, some amputees experience phantom sensations, including movement, temperature, pressure, vibration and itch.
All pain should be reported to your doctor, your prosthetist and your clinical therapy specialist. It’s important to describe to them the types of pain/sensations you are feeling. Although focusing on pain is not helpful, keeping a brief journal to note what you were doing at the time of the sensation, how it felt, and how long it lasted can be useful when discussing the pain with your care team (you might find it most convenient to record these via your voice onto your phone to transcribe later).
One of the reasons you want to make sure to report these incidents is because the pain may not be phantom pain. If you feel pain while wearing your prosthetic device, you may not have a perfect fit, or a comfortable socket. In some cases, further surgery may be necessary to remove a bone(s) from the amputated area that could be causing the pain. Again, your doctor, prosthetist and therapist should be able to determine the cause of the pain.
If you feel that your prosthetist is not listening to your concerns, exploring what options are available from other prosthetists may be necessary. At our Arm Dynamics centers, we have fit many patients with a new device after they have moved on from their first prosthetic device provider.
If it is indeed phantom pain, there are several options that are available to mitigate the issue. These range from over-the-counter painkillers to prescription drugs; from mirror therapy to acupuncture; and from spinal cord stimulation to a variety of surgical interventions, including Targeted Muscle Reinnervation (TMR).
Our clinical teams use novel assessment tools to understand our patients and the challenges they face. We start during the patient evaluation with the Wellness Inventory which screens for pain and other common conditions of amputation. The Comprehensive Arm Prosthesis and Rehabilitation Outcomes Questionnaire (CAPROQ) is the tool we use to specifically assesses pain and numbness, including phantom limb pain. Our goal is to make sure that you are able to return to as much of your pre-injury function as possible without post-amputation pain inhibiting your progress. Traditional therapeutic approaches to pain management include desensitization methods, as well as Graded Motor Imagery and Mirror Therapy specifically to address phantom limb pain.
If you would like more information about how we can help you assess and manage any pain that you experience after an upper limb amputation, please contact us. If you have a success story, or tips about how to mitigate pain, we’d love for you to share them with your peers — please write them in the comment section below!
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