Treating Phantom Limb Pain with Ketamine
What is Phantom Limb or Phantom Limb Pain?
Phantom limb is the sense that a missing or severed limb (or even an organ, such as the appendix) is still linked to the body and moving normally with other body parts. Around 5-10% of patients who have had a leg amputated experience phantom sensations in that limb, the majority of which are painful. Phantom sensations can also occur after the removal of body parts other than limbs, such as the amputation of the breast, tooth extraction (phantom tooth pain), or the removal of the eye (phantom eye syndrome). It’s common for the missing limb to seem shorter and malformed, and it could be in a painful posture. Changes in the weather, stress, and anxiety can all exacerbate the discomfort. Phantom limb soreness is usually only noticeable for a short time. Attacks usually become less frequent and less intense with time.
People who are born without limbs or who are paralyzed may experience phantom pains, which are a slightly distinct sensation. When nerves that would ordinarily innervate the missing limb create pain, this is known as phantom pain. Symptoms of Phantom Limb include a burning sensation, and it can be excruciatingly painful for some people, although the actual sensation varies greatly from person to person.
Clinical Description of the Phantom Limb
Although not all phantom limbs are unpleasant, patients may experience sensations such as pointing, itching, twitching, or even attempting to pick things up.
Some patients with phantom limbs notice that while they talk, the limb will gesticulate. (However, it’s uncertain whether they can feel the weight of the phantom limb while gesticulating.) This can be explained based on how the hands and arms are represented in the motor cortex and language areas. Some patients report that their phantom limb feels and acts like it’s still there, while others report that it takes on a life of its own and refuses to obey their directions.
Symptoms of Phantom Limb
- Pain that comes and goes
- Shooting pain
- Pins-and-needles sensation
Neurology of the Phantom Limb
Until recently, the most common explanation for phantom limbs was irritation in severed nerve endings (also known as “neuromas”). Many severed nerve endings are terminated at the remaining stump when a limb is removed. These nerve terminals can become inflamed, causing abnormal signals to be sent to the brain.
In severe situations, surgeons may conduct a second amputation to shorten the stump in the hopes of eliminating the irritated nerve endings and providing temporary respite from the phantom agony. Instead, the patients’ phantom pains worsened, and many of them were left with the sensation of both the original phantom limb and a new phantom stump, each with its own anguish. In some instances, surgeons have had to sever sensory nerves running into the spinal cord and, in extreme cases, destroyed the section of the thalamus that receives sensory impulses from the body.
Tim Pons of the National Institutes of Health (NIH) demonstrated in the early 1990s that sensory input can cause the brain to restructure. The right hemisphere receives input from the left side of the body, and vice versa. The somatosensory homonculus is a depiction of the sequence in which the input from the extremities enters the somatosensory cortex. The input from the hand is next to the arm’s input, the input from the foot is next to the hand’s input, and so on. One peculiarity is that face input is placed adjacent to hand input.
Ketamine Treatment for Phantom Limb Pain
Phantom Limb discomfort can be efficiently treated with IV Ketamine Infusion Therapy. SCS (spinal cord stimulation) is a therapy option for phantom pain. An electrode is put adjacent to the spinal cord, and an electrical stimulator is implanted under the skin. An electric current stimulates the nerve pathways in the spinal cord. This reduces the discomfort in the phantom limb by interfering with the signals that flow to the brain. Amputees instead experience a tingling sensation in their phantom limb.
Treatments such as vibration therapy, acupuncture, hypnosis, and biofeedback may be used to cure phantom pain, but they are typically ineffective. Attempting to distract yourself and take your mind off of the discomfort may help. It may be beneficial to massage the stump.
While patients may find relief through various forms of therapy, numerous patients are reporting tremendous relief and benefits when treating their phantom limb with ketamine therapy. Recent studies have shown that ketamine provides tremendous relief when treating the pain associated with phantom limb.
Phantom pain can be decreased by preoperative pain management, but good pain control with analgesics or neuroleptics is essential for planned amputation. The preoperative sensations appear to be implanted in the brain.
What is Ketamine?
Ketamine was FDA approved for use as a dissociative anesthetic and analgesic medicine in the 1970s. Ketamine was shown to have powerful antidepressant properties in the 1990s. Ketamine works on the glutamate system in the brain to mend damaged synaptic connections and urge the brain to generate new, healthy neural pathways when administered as an antidepressant.
Ketamine has remarkable antidepressant effects when given intravenously at low dosages. At New Horizon Clinics, we’ve found that a two-week first regimen of 4-6 ketamine infusions is successful for roughly 70% of patients, including those who have previously failed various depression treatments. Most patients will know whether ketamine will work for them within 1-2 infusions. Each infusion lasts around 40 minutes, and the most common side effects are nausea and mild, non-threatening hallucinations.
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Side-Effects of Ketamine
According to the Alcohol and Drug Foundation, the following have been reported as side-effects associated with ketamine therapy. You should contact your doctor if you experience any of the following:
- Decreased sensitivity to pain
- Anxiety or panic
- Increased heart rate
- Increased blood pressure