Is phantom pain really pain

Phantom painWhen it tweaks, where nothing can tweak

"You can tell when your legs are no longer there, pain down to the little toe, very extreme, but despite all that, when it's not there, you always have the feeling that something is tickling somewhere, that it is itches that you try to scratch yourself, but of course every time you reach into the void because there is nothing left, and these sensations are so precise that I can say for sure that this is now between the big and the little toe, me can therefore describe exactly where the pain is now. "

Werner Grunholz was so badly injured in a plane crash in the German armed forces that - after many other interventions - both legs had to be amputated in the end.

Even if the numbers fluctuate: In any case, well over 50 percent of people suffer from minor paresthesia through to severe pain in the limbs that are no longer there after amputations. Phantom pain is not crazy.

"You can actually measure and prove that electrical impulses arise in this nerve stump where the amputation took place. There are other components to this, namely, for example, psychological components."

The cause is in the brain

Professor Christoph Stein, Head of the Department of Anaesthesiology and Pain Therapy at the Charité in Berlin, can understand that the emotional stress caused by the loss of arms or legs also plays a role. The main cause, however, lies in the neurophysiology: phantom pain is an expression of the rewiring of the now more or less unemployed brain cells.

"This can arise because an area in the brain - there are actually areas of the brain that are assigned to individual body regions - is no longer excited because the foot is no longer there, but other areas are expanding. So that means areas that are excited in the brain, for example by impulses that come from the arm or that come from the opposite foot, actually expand in the brain. "

The nerve cells in the brain that are responsible for the missing link are still there - but nothing gets through to them. So they take impulses from neighboring regions and send signals to the nerves ending in the stump. This "remapping", that is, the new division of the map in the head, leads to the illusion that one can feel the missing body parts.

"I woke up from anesthesia and had phantom pain."

However, the transmission error can only appear years after the operation. The severity of phantom pain also differs from patient to patient. Werner Grunholz, now 66, was hit particularly hard.

"So it started with extreme electric shocks, it was just like that if I put two fingers into the socket, I would get an electric shock. But I also had boring pain, as if someone hit me in the leg with an ax, or it would run off , or stab your toes or a knife and turn it around - it was just beastly, I have to say. "

Those affected often encounter a lack of understanding

The former member of the Bundeswehr, like many of his comrades in fate, encountered incomprehension, which outsiders can already imagine that legs hurt that are no longer there. Support from friends and family, if necessary a self-help group, activity, as far as possible - all of this can help those affected. However, it is particularly important to find the right doctors, for example in a specialized pain clinic. Christoph Stein describes the basic therapy options that go beyond pure pain medication.

"There is a large group of drugs, anti-epileptics, which directly reduce the excitability of nerve fibers. But that is usually not enough, which means that - as with all other chronic pain conditions - you always combine psychological and physical approaches ; Physical therapy is particularly necessary for patients who wear prostheses; and there are also approaches in behavioral therapy, where the patient is taught through learning processes how to better deal with this pain and how to reduce it. "

Using various methods to outsmart the brain

Patient Grunholz had to go through several stages of treatment. It started with a catheter ...

"And then I was able to operate it myself with this anesthetic. So when I was in extreme pain, I could administer this drug to myself, which was also quite useful in the beginning, but it worked for perhaps nine months."

So next, the doctors prescribed a mixture of different drugs.

"And this cocktail in and of itself had the advantage that I had a good two years of rest. But unfortunately - after these two years the same ordeal began again."

And so the specialists had to try another method, a brain stimulator.

"And there I had a switching device, and it was programmed via a computer so that I could try to break the receptors to the brain with electric shocks. And that, I have to say, helped wonderfully for three years."

When this effect also subsided, there was nothing else to do but stop Werner Grunholz permanently on opiates. Professor Stein also knows that this can lead to drug addiction:

"The danger is always there with opiates ..."

But when the pain is so severe, the advantages of these remedies outweigh their disadvantages when properly dosed.

"I still have that to this day and now for almost six years; I still have phantom pain in between, but just within tolerable limits for me, and I have to say: toi toi, you can make ends meet very well so that I can participate in life normally again and am in a really good mood, in a very good mood. "

In addition to the at least mostly successful treatment methods, more obscure means are propagated, such as foils drawn over the stump or support stockings, which are supposed to shield against electromagnetic influences - although there is no evidence that artificial rays cause phantom pain.

On the other hand, the rather new "mirror therapy", developed by an Indian neurologist working in the USA, seems to be interesting. The patient places a mirror next to the leg that is still there in such a way that he can think it is the amputee. In this way he tricked the corresponding brain regions. Christoph Stein:

"This is a method that goes into the field of physical and psychological approaches, it is ultimately about exercise therapy, where one learns to be able to use the non-existent limb with a prosthesis again as best as possible, and there you can completely make good progress. "

Prevent phantom pain

The question remains whether the phantom pain cannot be prevented with modern anesthetic and surgical techniques.

"You cannot completely prevent amputation pain, but you can reduce the likelihood of severe pain; during the operation the nerve impulse that later goes from the periphery to the spinal cord or the brain is interrupted to such an extent that plastic changes in the brain are at least reduced . "

Overall, however, the phenomenon cannot be prevented entirely.

The even stranger counterpart to phantom pain, on the other hand, is more anecdotal: Experts recently reported, for example, about a woman who, after a stroke, was convinced that she had a third arm and that she could even see and use it.