September 16, 2016
It’s estimated that about 90-98% of people who undergo a limb loss or amputation experience phantom sensations or phantom limb pain (PLP). In other words, they experience discomfort that feels like it’s coming from the now-absent body part. This of course, makes PLP tricky to treat, and can be an especially frustrating process for a recovering addict who can’t risk his or her sobriety with painkillers.
Whether you’re a recent amputee or have been struggling with phantom pain for many years, there are options for relief that won’t compromise your recovery — and this guide will lead the way. It will help explain the theories behind what causes phantom pain, the risk that treatment of PLP poses to those with addiction history, and alternative therapies to try. Remember to always consult with your physician before seeking any kind of treatment or medication.
How Phantom Limb Pain Works
To be able to properly treat your PLP, you need to have an understanding of how pain is interpreted. The brain has what’s referred to as a sensory map, where each body part is represented by a physical area of the brain. When someone touches your hand, for example, your hand sends a message to specific neurons in its section of the brain, and you physically feel the contact. (Of course, this all happens very quickly!)
However, after an amputation, the brain still continues to perceive the body part as being there — even though you can’t physically see or touch it. To the brain, that part of the sensory map simply sees a cessation in stimulation. Research has shown that after an extended period, the neighboring areas begin to encroach and take over the now-inactive section of the brain. This is referred to as plasticity, meaning the brain can change itself over time. For example, this is used to explain why some amputees report that when they scratch their cheek, they feel the sensation in their missing limb, as well; the face section of the brain’s sensory map has moved into the unproductive space for its own purposes, causing touch sensitivity in both places.
When it comes to phantom pain specifically, there are a few different theories. Some experts believe that it is this brain reorganization (plasticity) that causes PLP. Others say that PLP comes from the disruption of activity in the sensory processing section of the brain. It’s also possible that both factors contribute to phantom pain. Keep in mind that while there is much evidence on these theories, scientists are still working to fully understand phantom limb pain and its official, definitive source (or sources).
While it might sound like a scary thought that the issue is actually taking place in your brain, this is actually a positive thing for recovering addicts worried about treating phantom limb pain. It suggests that treating PLP with painkillers wouldn’t be effective anyway — so you don’t actually have to sacrifice the best kind of therapy. Retraining your brain will call for professional assistance, but it’s not nearly as complicated as you might initially think.
Addiction and PLP treatment
Keep in mind that pain stemming from a poorly-fitted prosthetic or complications from the amputation are not considered phantom pain, so it’s important to get a comprehensive evaluation and diagnosis from your doctor to ensure you treat the correct kind of discomfort. Be sure to discuss your history of addiction early on so he knows to take a more holistic course of treatment.
Your physician may start out suggesting a non-invasive therapy like acupuncture. Scalp acupuncture has proven to be especially effective for phantom limb pain, especially when focused in the sensory and motor areas. Treatments typically last 30-45 minutes with stimulation every 1-2 minutes, and relief is often felt within minutes of starting.
There has also been significant success with actually retraining your brain to help it adapt to the changes in your body. Visualization therapy is a big part of this: for example, patients spend time imagining themselves walking with a lost limb with no pain or trouble. The idea is that by visualizing the process, you teach and prepare your brain to do an action the correct way so that when the time comes to perform, it knows exactly what to do and functions properly.
Mirror therapy is another method for retraining your brain and ties into the visualization effect. Patients use a mirror to reflect the image of their healthy limb and use it to trick their brain into seeing their amputated limb. By watching the reflection, they can seemingly move, massage, or scratch their phantom body part and relieve much discomfort. Though you’ll want to start out with a professional therapist to get you started, it’s likely that he or she will have you complete mirror exercises at home, as well. Mirror therapy has helped greatly reduce PLP in many, and for some, has helped defeat it completely.
Cognitive behavior therapy (CBT), which is often used as a part of addiction recovery programs, is often incorporated into phantom limb pain treatment. This approach focuses on the idea that negative feelings can actually increase a person’s sensitivity to pain. So by transforming negative thoughts into positive ones, you can not only increase your confidence in your ability to overcome pain sensations, you can truly reduce your own pain perception.
Nerve cuff stimulation at the site of amputation is another valuable option for recovering addicts struggling with PLP. First, doctors place a small nerve stimulator on the nerves leading to the amputated body part. When the patient feels discomfort, he or she presses a button to deliver an undetectable electrical pleasant stimulation that replaces the pain sensation as it makes its way to the brain.
There is still much to be learned about phantom limb pain and the best ways to both prevent and treat it. What’s promising is that research on PLP is not only ongoing, it’s constantly seeing progress and updates.
Work with your physician to find an effective course of holistic therapy, and don’t lose sight of your program steps along the way. Share your journey to find the right pain treatment with your recovery sponsor and any support groups you’re a member of. It’s important not to face the struggle alone and to surround yourself with the right cheerleaders.
The key is to remember that most evidence suggests that phantom limb pain is coming from your brain’s attempt to understand the loss, not from the loss itself (or the remaining stump). That certainly doesn’t mean that your pain isn’t real — it absolutely is — or that your doctor won’t take it seriously. It simply means that your perception and attitude about overcoming the pain will play a major role, and that you can’t lose sight of the fact that, no matter what the pain may tell you, an opioid likely won’t help. At most, it would be a temporary fix, but a major detriment to your recovery.