Minimally Invasive Surgery For Phantom Limb Pain
Phantom Limb Pain
For those who have had to undergo an amputation of a limb, one common occurrence they experience is known as phantom limb pain. Phantom limb pain is described by WebMd as a condition where, “mild to extreme pain [is] felt in the area where a limb has been amputated…limb sensations usually will disappear or decrease over time; when phantom limb pain continues for more than six months, however, the prognosis for improvement is poor.” They further explain, “although the limb is no longer there, the nerve endings at the site of the amputation continue to send pain signals to the brain that make the brain think the limb is still there.”
The Brain and Its Pain Signals
With a condition which already may be traumatic, phantom limb pain seems to feel like some kind of cruel trick the brain plays on those who suffer from it. The brain’s central nervous system is a powerful instrument. It both tells us when certain parts of our body are in danger, and with phantom limb pain, it has a “memory” of pain the limb has already undergone, continues to send pain signals to the area, although the limb itself is no longer is there.
Due to both the physical and psychological discomfort phantom limb pain can elicit, researchers have been studying how to reduce, or even eliminate, this phenomenon.
The good news is that a recent study has concluded some positive results of a treatment to “freeze out” the pain sent to the phantom limb using minimally invasive surgery.
The study was conducted by interventional radiologists. According to Johns Hopkins, Interventional radiology is, “a medical sub-specialty of radiology utilizing minimally-invasive image-guided procedures to diagnose and treat diseases in nearly every organ system…to diagnose and treat patients using the least invasive techniques currently available….These procedures have less risk, less pain and less recovery time in comparison to open surgery.”
The findings were reported at the Society of Interventional Radiology’s 2016 Annual Scientific Meeting. Performed at Emory University, physicians applied cryoablation therapy: a minimally invasive treatment using cold blasts, show promise in improving the quality of life for patients suffering phantom limb pain.
20 patients underwent an image-guided cryoablation of the nerve and scar tissue in the part of the limb that remained after amputation. They then inserted a probe with exact precision through the skin and dropped the body’s temperature of the body for 25 minutes to create an ablation zone (the removal of abnormal growths, organs, or harmful substances from the body through mechanical means, such as surgery) and thereby shutting down nerve signals. After the procedure, patients were asked to rate their pain using the visual analog scale (VAS) that ranged from 1 (not painful) to 10 (extremely painful), which was rated first before the surgery, seven days after, and finally 45 days after the procedure. Before cryoablation, patients reported an average pain score of 6.4 points. By day 45, the average score was 2.4 points: a significant decrease.
Regarding the study, J. David Prologo, M.D., assistant professor in the division of interventional radiology at Emory University School of Medicine, stated,”Until now, individuals with phantom limb pain have had few medical interventions available to them that resulted in significant reduction in their pain….Now…these individuals have a viable treatment option to target this lingering side effect of amputation—a condition that was previously largely untreatable.”
Amputees in America
There are currently millions of people in the U.S. living with amputated limbs. Military veterans wounded in combat and people with complex medical conditions, such as uncontrolled diabetes, are three of the largest populations affected by phantom limb pain. According to the Centers for Disease Control and Prevention, nearly 200,000 amputations occur each year.
Hope Through Minimally Invasive Surgery
Though much work needs to be done in this area of research, the conclusions bring positive news to those who are already suffering from the loss of a limb. Dr. Prologo elaborates,”Many of the nerves contributing to these pains are inaccessible to physicians without image guidance….With the interventional radiologist skill set, we can solve tough problems through advanced image-guided therapies, and this promising treatment can target hard-to-find nerves and help amputees dramatically improve their lives—all in an outpatient setting.”
As minimally invasive surgery continues to be used for a wider variety of conditions, both researchers and physicians performing the surgeries are giving the patients a much greater quality of care. With limited invasiveness, and improvements in ceasing pain that before had no cure, is not only encouraging to those surgeons using minimally invasive surgery practices, but most importantly to the patients: limiting their pain, suffering, and hopefully, giving them a greater chance for ease, acceptance, and a more promising future
- 2016. ‘Minimally Invasive Treatment Could Freeze out Phantom Limb Pain’. 2011. Accessed April 23, 2016.
- Accessed April 23, 2016. http://www.hopkinsmedicine.org/interventional-radiology/what_is_IR.html.http://medicalxpress.com/news/2016-04-minimally-invasive-treatment-phantom-limb.html.
- Dictionary. ‘The Definition of Ablation’. Accessed April 23, 2016 http://www.dictionary.com/browse/ablation.
- ‘Percutaneous Image-Guided Cryoablation for the Treatment of Phantom Limb Pain in Amputees: A Pilot Study – Journal of Vascular and Interventional Radiology’. March 1, 2016. Accessed April 23, 2016. http://www.jvir.org/article/S1051-0443(15)01729-7/abstract.
- ‘Phantom Limb Pain’. April 28, 2015. Accessed April 23, 2016. http://www.webmd.com/pain-management/guide/phantom-limb-pain.