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Phantom pain

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From MayoClinic.com 



Doctors use several approaches to treat phantom limb pain.

The first approach is often medications. No medications have been developed specifically to treat phantom pain. No drug works for everyone, and medications don't help everyone. People with phantom pain may need to try several different drugs to find one that works. Medications commonly used to treat phantom pain include:

  • Calcitonin (Miacalcin). Intravenous infusions of calcitonin during the week after amputation can reduce phantom limb pain. Calcitonin is a hormone produced by the body that lowers calcium and phosphate levels in your blood and slows the rate at which your body breaks down bone. Researchers aren't sure why it provides pain relief.

  • Antidepressants. Amitriptyline (Elavil), a tricyclic antidepressant, sometimes relieves phantom pain. Doctors prescribe a lower dose for phantom pain than that for depression, so side effects may be less severe. You'll need to take amitriptyline for one to two weeks before you notice an effect, and you may not receive the full benefit for four to six weeks. Amitriptyline may also promote sleep, which can make you feel better. Additional tricyclic antidepressants that may provide pain relief include doxepin (Sinequan), desipramine (Norpramin), nortriptyline (Aventyl, Pamelor), imipramine (Tofranil), venlafaxine (Effexor) and bupropion (Wellbutrin).

  • Anticonvulsants. When antidepressants don't ease phantom pain, doctors may prescribe the anticonvulsant drug carbamazepine (Carbatrol, Tegretol). Carbamazepine controls some types of seizures in the treatment of epilepsy and relieves the facial pain of trigeminal neuralgia. Other anticonvulsants that may reduce phantom pain include gabapentin (Neurontin), lamotrigine (Lamictal), phenytoin (Dilantin, Phenytek), tiagabine (Gabitril), topiramate (Topamax)and valproic acid (Depakene). As with other pain medications, they don't work for everyone.

  • Chlorpromazine. Doctors usually use the drug chlorpromazine (Thorazine) to treat psychotic disorders such as schizophrenia. Sometimes it offers relief to people with phantom pain.

  • Central nervous system depressants. Clonazepam (Klonopin) is a benzodiazepine, a drug that slows down the central nervous system. It has many uses, including as a treatment to relax muscle spasms. Clonazepam may relieve phantom pain for some people.

  • Opioids. Opioid medications, morphine and related painkillers, may be another option. Taken in appropriate doses, they may provide acceptable control of phantom pain. However, they may not be appropriate for people who have a history of substance abuse or pulmonary disease.

  • Ketamine (Ketalar, Ketaject). An anesthetic originally developed for use in animals, ketamine has some effect on phantom pain. Hallucinations and delirium are among ketamine's side effects, however, so doctors don't usually prescribe it unless other drugs have been ineffective.

  • Clonidine (Catapres). This drug is primarily used to treat high blood pressure. Because it affects pain pathways, it can also be very helpful in a variety of central pain syndromes, such as phantom pain.

  • Baclofen (Lioresal). This drug is a muscle relaxant and anti-spasticity drug. It can be used to treat nerve-related (neuralgic) pain syndromes, painful muscle spasms associated with central lesions and abnormal nerve (neuropathic) pain syndromes.

Nonsurgical approaches
As with medications, treating phantom pain with nonsurgical therapies is a matter of trial and observation. The following techniques may relieve phantom pain:

  • Transcutaneous electrical nerve stimulation (TENS). In this approach, a tiny electrical current is applied at specific points on a nerve pathway. Electrodes placed on your skin make it possible to deliver the current exactly where it's needed without causing further pain. This procedure is effective for treating stump pain, which is often associated with phantom pain. It isn't used to treat phantom pain. Treatments can be repeated as necessary without the need for surgery, and there are fewer side effects than with medications. TENS may be a good approach for people who can't take or don't get relief from medications.

  • Transcranial magnetic stimulation. In this procedure, an electrical current passes through a wire coil located inside a hand-held device, which is held against your scalp. The electrical current creates a strong magnetic pulse that passes through your scalp and skull when the device is held to your head. The magnetic pulse stimulates nerve cells located in the underlying brain. Pain relief may last for a week or longer, and you'll need repeated treatments. This procedure is experimental when used for pain syndromes.

  • Electroconvulsive therapy (ECT). This noninvasive approach involves applying a small electrical current through the brain to cause a seizure. Before the current is administered, you receive medication to prevent pain and physical injury during the seizure. Although ECT is usually used to treat depression or other mental disorders, it can be effective against phantom pain.

If drugs and noninvasive procedures fail to provide relief, surgery may be an option. Surgical options include:

  • Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord sometimes results in pain relief.

  • Deep brain stimulation. Deep brain stimulation is similar to spinal cord stimulation except that the current is delivered to the brain. A surgeon uses a magnetic resonance imaging (MRI) scan to position the electrodes correctly.

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