Phantom Limb Pain / Persistent Pain

There is a most peculiar form of pain called "phantom limb pain". This pain occurs in a part of the body that has been amputated. The pain is described as completely unbearable by many of the amputees. Phantom limb pain has even driven some victims crazy. Many thanks to Toni Ray for some of the descriptions below, which were excerpted from her paper, "Helping Phantom Limb Pain".

After James Peacock had his right arm amputated last December, he expected some difficulties. With those difficulties came pain so unbearable it could not be controlled with all the medicine in his cabinet. Derek Steen, otherwise known as "The one-armed pool player", lost a limb in a motorcycle accident at the age of 18. Although he lost the limb, he still plays a great game of pool. Nine years after the accident, Steen continues to have pain in the missing arm. Deborah Finnegan-Ling, a graduate student in neuroscience, is writing her dissertation on phantom limb pain. Finnegan-Ling should know a lot about this phenomenon because three years ago, after a farming accident, her left leg was amputated. She has experienced much pain from this phantom limb, especially in her personal life. The area of the brain for the foot is adjacent to the area for genitalia. Because of this connection, Finnegan-Ling's missing limb aches when she makes love. "I consider myself tough," she says. "But the pain is so acute that I'll cry.

"Some amputees experience the opposite of phantom pain - phantom pleasure. One man tells about feeling an orgasmic sensation in his lost foot during sex. Finnegan-Ling sighs. "I wish", she says.

How can something that is not physically there cause so much pain? Scientists have proposed several different explanations. One explanation that makes a lot of sense to us at the Pain Relief Center is that a severe trauma creates such an incredible barrage of pain impulses in a nerve pathway that it "burns in" a pattern of pain. A nerve circuit that is so traumatized continues to transmit painful impulses to the brain. It is as though the nervous system develops a bad "habit" of pain by continuing to act as though there was a physical injury. It is sort of like letting a hot iron sit on the ironing board too long - it leaves an indelible burn mark.

What can we do to alleviate phantom limb pain? Many clinical studies have shown that there are three effective psychological approaches: relaxation training, hypnosis, and biofeedback. We have described these techniques in previous lessons. The type of biofeedback used in many of these studies is simply learning to warm the hands. The common factor with all three of these treatments is that they can be used to counteract the defensive reflex, which is a major component of our experience of suffering. The defensive reflex, or fight/flight reaction, makes any physical pain much worse. Relaxation training, and of course meditation, are very simple techniques that are effective for most types of pain. Hypnosis is also an effective technique, especially for those who are more easily hypnotized.

It is particularly interesting that phantom limb pain, like most types of pain, is increased by stress. A study by Arena, Sherman, Bruno, and Smith (1990) examined the relationship between situational stress and phantom limb pain in male amputees. Seventy-four percent of subjects demonstrated some significant stress-pain relationship. This reinforces the conclusion that stress is an important contributor to physical pain, and that anything you can do to relieve stress will decrease pain. If you or someone you know has phantom limb pain, you might try some of the techniques we have outlined in previous lessons. We particularly recommend relaxation training and meditation, in conjunction with turning your awareness toward the pain, rather than away from it. Anything that will diminish the defensive reflex, or the fight/flight response, will help alleviate the pain.

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Persistent Pain

Anytime a person has a severe trauma, the same mechanism that causes phantom limb pain can come into play. A severe trauma can "burn in" a pattern of pain in a nerve circuit, and the pain can persist long after the trauma has healed. For example, suppose you have a severe back injury that causes excruciating pain. The injury can heal, but you can still be in extreme pain because the nervous system continues to act as though the injury was still there. Additionally, you can develop other bad "pain habits", such as continuing the attempt to fight or escape from the pain, defending yourself against the pain by bracing, tightening muscles, or lapsing into inactivity. All of these are very bad habits, and will contribute to ongoing suffering, even long after the original injury has healed. You may think your pain is due to an unhealed injury, but consider this: if a person can have pain in a missing limb, how can you be so sure about the cause of your pain?

How do you know if you are afflicted with this sort of pain? First, you can use some of the techniques in previous newsletters to stop fighting or escaping from the pain. Train yourself to achieve a completely relaxed state. Then get into this relaxed state and gently turn your attention toward the pain. Pay close attention to the pain - try to locate it precisely, and describe it. If the pain changes significantly or moves, then most likely you have developed "pain habits". Your primary injury may have healed at least partially. Many of our clients have reported that when they relax and try to locate their pain exactly, it moves. Several men have complained of chronic, severe pain in their lower back and hip. When they relaxed and tried to locate the pain precisely, they discovered that it moved down their leg. For some, the pain ended up in their foot, amazingly. When they continued to focus their relaxed attention to the new location, it eventually eliminated the pain completely. Thus, it is possible to undo these bad "pain habits", although it does take some persistence.

It is also important to realize the extent to which stress contributes to physical pain. We have noticed that when some people apply the aforementioned techniques to headache, they can get their headache to go away completely. Unfortunately, they then develop back, shoulder, or neck pain. Most likely this is because the original pain was caused by stress. Once they have learned to prevent the stress-induced headache, the symptoms move elsewhere. This is very common - many people complain of one stress-related problem, such as gastrointestinal disturbance. They find some treatment or medicine that makes that symptom go away, but very soon thereafter they develop a new symptom, such as headache. If they find a medicine that makes the headache go away, up pops a new symptom, such as muscle pain. This goes on and on until they can no longer find an effective treatment for their latest symptom, which then becomes a chronic ailment. This pattern is very common and unfortunate, because it is so hard for people to recognize. The problem ends only when the person realizes the cause, takes some time to make important life decisions, and applies some stress reducing techniques.