Amputees may wish to try massage and chiropractic for phantom limb pain.
Reasons for Amputation
There are nearly 2 million people in the US living with an amputation. Amputation is the removal of part or all of an extremity or limb. The parts commonly involved in surgical removal are toes, fingers, legs, feet, hands, legs, or arms. Poor circulation, such as from peripheral arterial disease, may be one reason to amputate. Blood flow is necessary to give the cells nutrients and oxygen. With poor circulation, the tissue can become infected and die. Other reasons for amputation include severe injury, such as from a burn or car accident, cancer, an infection that is serious and has not cleared up with antibiotics or other means, a neuroma (thickened nerve tissue), or frostbite. The surgical procedure is generally followed by a week or two, or possibly longer, in the hospital. The anesthesia used is either spinal or general. Doctors determine how much tissue should be removed based on comparing skin temperature with a healthy limb, checking the pulse in relation to the planned cut, examining for reddened skin, and seeing if the skin near the incision site is sensitive. Any crushed bone or diseased tissue is removed during the procedure, and uneven bone areas are smoothed. Blood vessels and nerves are sealed off, and the muscles are shaped so the “stump” can have a prosthesis attached. A prosthesis is an artificial limb.1
What is Phantom Limb Pain?
When a limb has been amputated, there may be “mild to extreme pain” remaining in the amputated area. If that pain persists for over six months, the prognosis is poor. Phantom limb pain is caused by nerve endings at the amputation site continuing to send the pain signals so that the brain believes the limb is still attached. Pain is not the only type of signal sent, and some patients report cold, heat, tingling, and cramping.2 The pain or sensations begin within days of the amputation and they may be continuous or just come and go. Throbbing, burning, stabbing, and squeezing are other types of sensations. Emotional stress or physical pressure on the remainder of the limb can trigger these feelings. It seems that the brain and spinal cord cause phantom pain. Some studies show that the “brain may remap that…sensory circuitry to another part of the body”; therefore a patient missing a hand might feel sensation of the hand in their cheek, for example. Damage to nerve endings, scar tissue, and just the “physical memory of pre-amputation pain” can all contribute to phantom pain. Patients with the highest risk factors are those with pre-amputation pain, stump pain, or a poor-fitting prosthetic limb.3
There are many types of treatments for phantom limb pain, although successful treatment is challenging. Heat applications, relaxation techniques, biofeedback (to reduce tension in the muscles), steroid and anesthetic injections, surgery for scar tissue that impacts the nerve, physical therapy, TENS (“transcutaneous electrical nerve stimulation” of the stump), medications, nerve blocks, and massage are some treatment options. Neurostimulation techniques may also be used, such as deep brain stimulation and spinal cord stimulation. Medications include pain relievers, anticonvulsants, antidepressants, neuroleptics, sodium channel blockers, and beta-blockers. Very often, multiple treatment modalities need to be employed, and this is generally determined by the patient’s pain level.4 Other treatments include acupuncture, chiropractic, cold therapy, cranial sacral therapy, herbal and dietary supplements, exercises, desensitization, meditation, LaKOTA (an herbal analgesic), Farabloc (a thin fabric with steel threads meant to shield against magnetic influences and ions), shrinker socks (that apply pressure to the limb for relief), magnetic therapy, psychotherapy, and even keeping a journal.5 Mirror therapy is a promising option for amputees with phantom limb pain. For example, a patient missing a left arm could put the right arm into a box with a mirror to trick the brain into thinking that the left arm was still there. As a result, the patient can make movements with the existing arm while the brain perceives the missing limb as still existing. Without the sensory conflict, “the brain may simply gate the signals”.6
Massage has many benefits for patients, beyond just relaxation. It is a therapy available in hospitals, clinics, spas, and even businesses and airports. Massage involves pressing, manipulating, and rubbing the skin, tendons, ligaments, and muscles, via the therapist’s fingers, hands, elbows, feet, or forearms. Light stroking or deep pressure may be used. The basic types of massage include Swedish, deep tissue, trigger point, and sports massage. It is considered one of the “complementary and alternative medicine” therapies, and it is used to treat many conditions.7 Massage therapy is also beneficial to amputees. It can reduce swelling, improve circulation, decrease stiffness, reduce the tightness of scar tissues, decrease spasms and pain, improve mood and sleep, and help patients relax.8 Massage helps relieve painful sensations by restoring the blood flow and activating the sensory fibers. Pain signals can be inhibited by touching the skin with massage. One interesting and new technique is “virtual massage”. Vilayanur Ramachandran, creator of the mirror box for mirror therapy, noted that massage can be performed on the existing limb and provide the sensation that the missing limb is being massaged. Even watching “a volunteer’s hand being stroked…(led amputees) to experience a stroking sensation”. Because there is no feedback from the missing limb, the amputees had nothing in their body telling them that they weren’t being touched, therefore they received the benefits of having the limb being stroked. The mirror neurons were not inhibited. The pain resolution lasted several minutes, but, “it is hoped that “If you do it often enough perhaps this pain will go away for good,” suggests Ramachandran.”9
Simply put, chiropractic care “focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health”. Neuromusculoskeletal pain is commonly treated, and this includes pain in the joints, arms, and legs, as well as back pain, headaches, and neck pain. Doctors of Chiropractic use a hands-on, drug free therapy and can treat a variety of conditions. The most frequently used procedure is “spinal manipulation” or “chiropractic adjustment”. It is used to restore mobility to the joint that had been restricted or hypermobile due to tissue injury. When the mobility is restored, muscle pain and tightness are alleviated; therefore, tissues get a chance to heal.10 Patients with amputations of lower limbs commonly have spinal problems. In one survey, authors reported that “only opioids and chiropractic care were rated as moderately to extremely helpful” by most of the patients who had tried those interventions.11 In a recent case study, chiropractic care was used in “a 20-year-old woman with right transfemoral amputation and a right upper extremity amputation”, where the patient had pain due to her new prosthetic leg. She had pain when lying supine, exercising, or walking, and she was diagnosed with “sacroiliac joint dysfunction”. The patient’s prosthetic leg was shortened, resolving the leg length inequality. The chiropractor manipulated the pelvis and lumbar spine and used trigger point therapy. As a result, the patient’s gait improved and the pain was resolved after 18 treatments.12
Learn more about amputation and treatments.