Neuragenex

Phantom Pain

Know everything from causes, symptoms, to treatment.

Dealing with chronic pain, or discomfort in general, can be incredibly challenging. Even mild to moderate pain can affect your quality of life if it’s chronic. However, if you know the cause, then at least you can start managing it better. But what if you don’t know the cause of the pain? Even more confusing — what if you’re experiencing pain in a limb of your body that’s no longer there? This is exactly the case when it comes to phantom pain.

Phantom pain is a condition that affects upwards of 80 percent of all amputees and can be incredibly frustrating to deal with because the limb or body part is no longer there. Although phantom pain can go away on its own, it can also become chronic. Fortunately, there are ways that you can treat and manage phantom pain.

What Is Phantom Pain?

Phantom pain is a type of chronic pain that occurs when an amputated part of the body is still sending signals to the brain that it is there. As you can imagine, feeling such pain can be incredibly aggravating. Not only do you have to deal with the experience of feeling the pain, but the fact that the body part is no longer there can also result in mental distress. The following are some of the specific symptoms that patients with phantom pain often experience:

Phantom pain tends to occur in a continuous cycle. However, certain outside factors are known to contribute to the pain as well. For example, stress or even a change in temperature can bring on phantom pain in the amputated limb. With that in mind, the following are some of the common symptoms of phantom pain:

  • Pain And Discomfort In The Missing Limb Or Body Part : The main symptom of phantom pain is a sensation of pain or discomfort in the missing limb or body part. This can range from mild to extreme and typically occurs right after the amputation surgery.
  • Tingling, Burning, Or Stabbing Sensations : These types of pain tend to occur in the distal parts of the missing limb, such as fingers or toes. They are also the types of sensations that are generally linked with neuropathic pain .
  • Itching Or Other Abnormal Sensations : Patients with phantom pain may also experience sensations such as itching in the absent limb or a feeling of coldness.

Causes Of Phantom Limb Pain

The exact cause of phantom pain is still unknown, but doctors have identified a few factors that may contribute to the condition. These include:

  • Amputation : The nerves in the brain and spinal cord that were sending signals back and forth between the limb that was amputated and your brain can still be active and sending signals. When they lose the signal coming from the limb that was amputated, they can “rewire” and essentially send pain signals to the brain to tell it that something is wrong (that a limb is missing), resulting in phantom pain.
  • Physical Trauma : Trauma at the amputation site can also cause phantom pain. This is because when physical trauma occurs, it can disrupt the nerves and scar tissue that has formed around the wound. As a result, your brain may interpret the signals as pain or discomfort in the missing limb.
  • Neurological Disorders : Phantom pain is a neuropathic condition, so certain neurological disorders can also contribute to phantom pain. For example, if you are an amputee with a pre-existing neurological disorder, you may likely be more prone to experiencing phantom limb pain.

Diagnosis And Evaluation

You might think that a diagnosis would be clear-cut if you are an amputee and you’re experiencing symptoms of phantom pain in the limb that was amputated. However, this is not always the case. For example, you may feel pain at the amputation site due to nerve trauma, a poorly fit prosthesis, or other physical issues. Therefore, it is crucial to be evaluated by a doctor to determine the root cause of the pain and how it should be managed.

To diagnose phantom limb pain, doctors typically conduct the following:

  • Medical History And Physical Examination : The Doctor will conduct a physical examination of the affected area or areas and ask questions about your medical history and current symptoms. They will look for signs and symptoms that might indicate phantom pain, including changes in the skin temperature, sensitivity to light touch, swelling, and other abnormalities.
  • Imaging Tests : The doctor may order imaging tests such as an X-ray or MRI to determine the extent of any physical damage. Imaging tests can rule out other potential causes of pain, such as tumors, fractures, or damaged tissue.
  • Neuropsychological Testing : These tests help doctors measure how the brain responds to certain stimuli and may be used to detect phantom limb pain. Your mental function is tested by assessing your processing speed, reading comprehension, visuospatial skills, motor speed and dexterity, concentration, executive functions, mood, and more.

Phantom Pain Treatments Options

When it comes to the conventional treatment of phantom pain, the following are some of the common approaches:

  • Medications : Doctors often prescribe medications such as antidepressants, anticonvulsants, and even narcotics (medications containing opioids) to help reduce or manage the pain. The problem with these medications is that they can also have strong side effects and can be habit-forming, not to mention, they only treat the symptom and not the cause of the pain.
  • Physical Therapy : Physical therapy may involve gentle stretching and massage to help relax the muscles around the amputation site.
  • Mirror Therapy : Mirror therapy tricks your brain into believing you can still move the missing limb.
  • Cognitive Behavioral Therapy : Cognitive behavioral therapy (CBT) helps to teach techniques like relaxation and distraction, which can help you focus on something else other than the pain.
  • Physiotherapy : Physiotherapy and occupational therapy are also used to help improve the function of the remaining limb, which can reduce pain and discomfort associated with phantom limb pain.
  • Surgical Interventions : If the above treatments do not reduce phantom limb pain, a doctor may recommend more invasive treatments such as nerve blocks or spinal cord stimulation. These procedures involve blocking the nerves that send pain signals or stimulating them to reduce the sensation of phantom limb pain. The surgery involves implanting electrodes into the spine and sending electrical signals to interrupt pain signals from reaching the brain. But, of course, any surgical procedure comes with its fair share of risks, including infection, nerve damage, and long recovery times, and all without the guarantee that the phantom pain won’t go away.

How To Cope Up And Manage Phantom Pain

Despite being called “phantom pain,” it’s anything but an illusion — it can be very real and debilitating. Not only can phantom pain affect your physical quality of life, but it can also affect your mental and emotional well-being. Knowing this, you must take steps to manage your phantom pain to learn to cope with it and lead a more fulfilling life.

The following are some tips on how to cope with and manage phantom pain:

  • Creating A Support System : A support system is essential for managing phantom pain. Your family, friends, and healthcare providers can provide emotional support and help you understand your condition better. You must learn to share your feelings and experiences with those who understand so you don’t feel alone.
  • Practicing Mind-Body Techniques : Mind-body techniques like meditation, yoga, and tai chi help manage phantom pain. Additionally, visualization techniques can help you focus on something other than the pain, which can provide relief. These practices can help you relax your body and mind, which in turn can help reduce pain. They can also be incredibly useful for maintaining your mental health and emotional balance.
  • Cognitive Behavioral Therapy (CBT) : CBT is a form of psychotherapy focusing on the thought and behavior patterns associated with phantom pain. A therapist can help you identify any negative beliefs or attitudes you may have towards your condition, and help you find ways to change them. This can lead to a more positive outlook on life and improve self-management of phantom pain.

Electroanalgesia

Electroanalgesia is a pain management technique that uses high-pulse electrical current to ease pain , boost blood circulation, improve mobility, and induce...

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IV nutritional therapy, or intravenous therapy, involves administering vital nutrients directly to the bloodstream through an IV. This type of treatment bypasses the digestive system, allowing for maximum absorption and utilization of nutrients by the...

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Lifestyle Counseling

Lifestyle counseling is an approach to managing chronic pain that involves identifying, assessing, and modifying lifestyle factors contributing to an individual's pain. For example, lifestyle factors such as nutrition, physical activity, stress, sleep quality...

Read More About Phantom Pain Lifestyle Counseling

Achieve Long-Term Relief From Phantom Limb Pain

Living with phantom limb pain can be a challenging experience. But, with the right treatment and coping strategies, you can reduce your pain and improve your quality of life. Here at Neuragenex, we employ a Neurofunctional Pain Management treatment plan consisting of a whole-person, non-opioid, non-chiropractic, non-invasive approach to reducing pain.

This involves a combination of FDA-cleared electroanalgesia treatment, IV therapy, and lifestyle counseling tailored to your individual needs. We also provide emotional support and guidance to help you manage your condition and live a more fulfilling life. Contact us today for more information about how we can help you achieve relief from phantom limb pain.

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Dr. Victor Osisanya is Board Certified in Physical Medicine and Rehabilitation. He earned his undergraduate degree from the University of Michigan in Ann Arbor and his medical degree from Chicago Medical School. Upon completion of...

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Over the last 18 years he has worked in family practice and as a civilian contractor for the Department of State spending almost 5 years split between Iraq and Afghanistan. During his medical missions overseas,...

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John Ham is a board certified physician assistant with extensive experience working in rehabilitation services, musculoskeletal medicine, and pain management since 2004. He received his PA degree with a masters in medical science from Midwestern...

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Apputee

Understanding Phantom Pain: Causes, Symptoms, and Management

what is phantom pain caused by

If you’ve ever spoken to an amputee, you might have heard the term “phantom pain”. This term might sound like something from a science fiction novel, but it’s a very real phenomenon experienced by many people who have lost a limb. Let’s explore what phantom pain is, why it happens, and how it can be managed.

What is Phantom Pain?

Phantom pain is a sensation of pain that feels like it’s coming from a limb or a part of the body that’s no longer there. It is a common experience among amputees. The “phantom” pain can vary greatly among individuals, ranging from mild to severe, and may feel like throbbing, stabbing, twisting, or burning. Some amputees might get phantom non-pain in their missing limbs, like itching, twitching or even chills.

Why Does Phantom Pain Occur?

While the exact cause of phantom pain remains unknown, it is widely believed to involve mixed brain or spinal cord signals. When a limb is amputated, the brain may still attempt to send signals to the limb and receive feedback, leading to a pain sensation.

Symptoms of Phantom Pain

Phantom pain can begin shortly after the removal of the limb, although sometimes, there might be a delay of months or even longer. It’s often described as intermittent, but the frequency and duration of the pain episodes can vary widely. Various factors, including changes in weather, pressure on the remaining part of the limb, and emotional stress, can trigger the pain.

Managing Phantom Pain

Though phantom pain can be a challenging condition to manage, several treatments have shown promise:

  • Medications: Various drugs, from over-the-counter pain relievers to antidepressants and anticonvulsants, can help control phantom pain.
  • Non-Invasive Therapies: Techniques like mirror box therapy, which uses a mirror to create a reflective illusion of an intact limb, can sometimes be effective. Acupuncture and transcutaneous electrical nerve stimulation (TENS) may also help.
  • Mind-Body Practices: Meditation, relaxation techniques, and biofeedback can assist in managing pain and reducing stress.
  • Physical Therapy and Occupational Therapy: These therapies can aid in strengthening the remaining limb, improving overall mobility, and teaching strategies for daily tasks, which can indirectly help manage phantom pain.
  • Support Groups: Joining a support group can be very beneficial. It allows people to share their experiences and learn from others dealing with similar issues.

If you’re experiencing phantom pain, it’s important to communicate with your healthcare provider. They can help you explore treatment options and devise the best management plan. Remember, it’s about managing the pain and enhancing your overall quality of life.

In conclusion, while phantom pain is a complex condition, advancements in medical science are constantly improving our understanding and treatment of it. With the right care and management, those experiencing phantom pain can lead a fulfilling and comfortable life.

Lydia Carrick

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Phantom Pain

What is phantom pain.

  • Amputee Rehabilitation Program
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  • Prosthetic Limb Fitting
  • After Amputation Surgery: Phantom Pain Treatment

Despite its name, phantom pain is a real, painful sensation that some amputee patients feel in a part of their body that no longer exists. The part of the body that is removed through amputation (surgically cutting off a limb) is referred to as a phantom limb. It may even feel like the phantom limb is still attached to your body. This condition affects up to 80 percent of people with amputation. However, it can be reliably treated so that most people experience a significant decrease in pain within two years of their amputation surgery.

Signs of Phantom Pain

You may experience phantom pain soon after your amputation or even in the weeks or months afterward. The pain in the missing limb may be ongoing or unpredictable. It is often worse at night when your thoughts turn inward as outside distractions subside.  You may feel pain that is:

  • pins and needles,
  • burning, or
  • similar to cramps.

The pain often feels as if it is located in the part that is the greatest distance from your healthy body. For example, after a leg amputation, the foot (which is no longer there) may feel phantom pain.

What Causes Phantom Pain?

Researchers are continually investigating additional causes and treatments for this unique phenomenon. However, they have discovered that phantom limb pain could be caused by a miscommunication between your brain, spinal cord, and nerves that continues after your amputation.

Other causes that can worsen pain may include: 

  • depression, and
  • pain in the limb prior to amputation.

Patients who experience pain in the limb before amputation often report phantom limb pain afterward in a similar way. Your doctor will make every effort to decrease your pain before surgery to lessen the chance of discomfort afterward. Additional pain management in the weeks after surgery can dramatically decrease your pain.

Find a Rehabilitation Specialist

Phantom pain treatment.

Alleviating phantom pain is possible. Many patients find significant relief through:

  • nonsteroidal anti-inflammatory drugs (NSAIDS),
  • nerve pain medications from a variety of classes, including antidepressants; anti-seizure medication;, and blood pressure medications,
  • desensitization (a home remedy that reduces hypersensitivity after an amputation),
  • behavioral strategies,
  • referrals to a rehabilitation psychologist ,
  • injections, and
  • surgery, such as targeted muscle reinnervation .

For some patients, wearing a prosthetic (artificial limb) more frequently helps decrease the level of pain. This is especially true in amputations of the hand and arm.

Phantom Pain Medication

Our physicians are committed to diagnosing the source of the pain to best address your symptoms. A spectrum of pharmaceutical options are available. Your physician will use opiates only when needed and taper them appropriately. Neuropathic medications and injections can also address specific and wider nerve pain.

Phantom Pain Remedies to Do at Home

For some patients, standard relaxation techniques help reduce their pain including gentle massage and listening to music. Our clinicians and therapists may also recommend other at-home approaches including:

Mirror Treatment

You can use a device called a mirror box with separate openings for your healthy body part and residual (remaining) limb. We provide mirror boxes for our patients on a case-by-case basis. However, you may order one online or ask your insurance company if they will cover the cost.

You can do this at home using the following instructions:

  • Place a mirror in the middle of your body to reflect your healthy leg or arm (or situate it to reflect whichever healthy body part you want to look at).
  • When you look in the mirror, it should now appear that you have two healthy arms or legs.
  • Practice doing movements with the healthy part of your body every day. You should be able to see your intact body part and the reflection.

Over time, many patients have seen a reduction in their pain.

Desensitization

If you experience hypersensitivity after amputation, your doctor may recommend this technique.

  • Rub material with a smooth texture over your skin on the residual (remaining) limb. Begin lightly and go in multiple directions.
  • Do this for several minutes a few times each day. You may feel some pain, itchiness, or discomfort.
  • When you stop the movement, the feeling should cease or decrease.
  • After a while, you can increase the pressure and change the texture of the material. A material such as corduroy or wool will feel rougher on your skin.
  • Over time, the sensitivity of your skin may decrease, which helps to decrease your pain and makes it easier to use a prosthetic.

Does Phantom Pain Ever Go Away?

Phantom pain does eventually go away with time. Many people find their pain has decreased by about 75 percent or more within two years after amputation surgery. If it does return, talk to your doctor. There may be an underlying problem—such as a neuroma (nerve overgrowth)—triggering the sensation.

Residual Limb Pain vs. Phantom Pain

After an amputation, some patients may feel pain in the remaining or residual limb. It is even possible for patients to feel residual limb pain (a non-bothersome sensation originating in the space where the limb used to be) and phantom pain at the same time.

The cause of your residual limb pain may be:

  • blood supply issues,
  • referred pain,
  • muscle strain,
  • neuroma or other nerve problems,
  • bone fractures, and
  • skin issues.

Residual Limb Pain Treatment

Managing this kind of pain may include:

  • over-the-counter pain relievers and some stronger medications,
  • antidepressants (off-label use for increasing neurotransmitters that reduce the perception of pain),
  • physical and occupational therapy ,
  • electrical stimulation.

Residual Limb Surgery

Occasionally, a residual limb (the remaining portion of the limb after amputation) has a shape, skin, nerve, or bone problem that can only be resolved with surgery. In these cases, our surgeons can reconstruct the residual limb for optimal success with a prosthetic. 

We use the most advanced techniques to restore strength, function, control, and avoid pain. One such approach is targeted muscle reinnervation (TMR) surgery where we split the ends of the nerves and place them into new muscles where they will grow into new muscle. This surgical procedure will prevent pain and allow robotic limbs to read signals from the muscles.

Another advanced and emerging technique we are studying is osseointegration. This is when a surgeon implants a titanium rod in your healthy bone to attach a prosthetic. The result is a lighter, stronger, and more natural artificial leg. Currently, University of Utah and the Veteran’s Administration are studying these implanted devices in the United States in hopes of gaining FDA (Food Drug Administration) approval and broader application.

Amputee Support Groups

We offer a monthly support group for amputees, their family, and caregivers.  

Date & Time Fourth Tuesday of every month (except July) at 7pm

Location Sugar House Health Center 1280 East Stringham Avenue, Salt Lake City, UT 84106

For more information, contact Spencer Thompson at  [email protected]  to confirm dates and times of upcoming meetings.

Meet with Our Amputee Program Specialists

For questions or information on how to meet with our specialists or participate in our inpatient programs at the Neilsen Rehabilitation Hospital , please call our referral line at 801-646-8000 . Our referral specialist will work with your current provider to obtain necessary medical records and verify your insurance benefits for coverage.

For outpatient physician clinic questions, call 801-581-2267 . For information about Sugar House Therapy Services , call 801-581-2221 .

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What causes phantom limb pain? A new theory

The phantom limb pain many amputees experience may be linked to residual representations of that limb in the brain, a new study finds.

"About 80 percent of amputees experience phantom pain," lead study author Tamar Makin, a neuroscientist at Oxford University, told LiveScience. "For many, the pain is debilitating, interfering with their day-to-day lives."

The causes of phantom pain have long baffled scientists, and treatments are limited. The brain is known to have a sensory "map" of different body parts, and previous research suggested that phantom pain results when the part of that map that represented the former limb is taken over by representations of other body parts (like the face and lips), a phenomenon known as plasticity. But new research suggests the ghost pain stems from lasting representations of the amputated limb. The findings are detailed today (March 5) in the journal Nature Communications.

Using functional magnetic resonance imaging (fMRI), which measures changes in blood flow due to brain activity, Makin's team scanned the brains of hand amputees , two-armed individuals, and people born with only one hand. As the participants were being scanned, they were told to move their hands, arms, feet or lips. Amputees with phantom pain were told to perform the movements with their phantom limb, whereas amputees with no phantom pain and those born without a hand were told to simply imagine moving their hand or arm. [ The 9 Most Bizarre Medical Conditions ]

The scans showed that amputees with phantom pain had the same pattern of brain activity as individuals with both hands. This was a huge surprise, Makin said. "If we take an individual who suffers from phantom pain, his brain would be indistinguishable from your brain."

In addition, the phantom pain was linked to disrupted activity between different parts of the sensorimotor cortex, the part of the brain that processes touch and movement.

While previous studies focused on how brain representations of other body parts usurp the area that once represented the amputated limb, Makin's study focused on the lingering representation of the limb itself. Makin's interpretation of her results is that the experience of pain is causing the brain reorganization rather than brain reorganization causing the pain.

"Makin and co-workers have directly challenged the notion that phantom pain as a consequence of limb amputation derives from reorganization of body parts that are represented in the somatosensory cortex [a mental map of body parts ]," neuroscientist Elena Nava of the University of Hamburg, who was not involved in the study, told LiveScience.

But physiotherapist Lorimer Moseley of the University of South Australia, who was not involved in the study, disagreed. The two explanations of phantom pain are different paradigms, Moseley said — "there is no reason to suggest that one is true and the other is not." However, he challenged the interpretation that the pain causes the brain remapping, because the experience of pain arises from the brain, he said.

The problem, Makin said, is the study shows that pain and remapping are correlated, but does not show that one causes the other.

Nevertheless, the study "confirms the idea that we might be able to treat phantom limb pain by treating that brain-map," Moseley said.

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Patient Information

what is phantom pain caused by

Phantom Limb Pain

After your amputation, it is absolutely normal to feel that the limb you have lost is still there, even people born without a limb will feel this Phantom Limb Sensation. If the sensations in your phantom limb are unpleasant, we call it Phantom Limb Pain. We know that pain before and after surgery increase the risk of Phantom Limb Pain, so these are really important times to work with your team to manage that pain.

What causes phantom limb pain?

Phantom limb pain can be unpredictable. You may feel it as soon as the anaesthetic wears off, though it may take time (even weeks) to appear. Sensations may change and often fade in time, or they may continue for years, even a lifetime.  Everyone’s experience of their phantom limb is unique to them, though there are some common experiences. Your phantom limb may feel stuck in a fixed position or it may move independently. Its movement may be appropriate (eg: reaching out for something) or quite random. Your limb may feel bigger or smaller, it may be in a natural position. It’s often in a similar position to when you last saw it, or it may be doing something weird like going through the bed or stuck in an anatomically impossible position. Typical Phantom Limb Pains include pins and needles, cramp, stabbing or burning sensations. No-one really understands exactly what causes Phantom Limb Pain. It has been suggested it may be caused by changes in the residual limb or in the central nervous system. However, this doesn’t really explain why the sensations seem to come from the space occupied by the missing limb or why some people born without a limb experience it. The answer probably lies in the brain where all of our experience is constructed. 

Mirror Therapy

An American neurologist called Ramachandran noticed that changes in body maps that exist within the brain are associated with Phantom Limb Pain. He suggested that Phantom Limb Pain is the brain’s response to being “starved” of feedback from the missing limb. And that if this were true, then tricking the brain into thinking that the limb still exists and is moving might be helpful. He was right. He created Mirror Therapy which we still use today. In fact, many forms of giving the brain this feedback, such as wearing a prosthetic limb, if possible, guided imagery or virtual reality are found to helpful by many people with amputations. We don’t really know why the brain behaves like this, but we do know our brains are always looking for threats to our safety and Phantom Limb Pain may simply be an anxious brain trying to get us to move a limb it thinks has been static for too long.

Using Mirror Therapy

As much as possible the limb reflected in the mirror needs to align with where the phantom limb is felt to be. This isn’t possible if the phantom limb is in a bizarre position. It can be a very emotional experience to apparently see the missing limb again. Some people say it is as if the limb is “plugged back in”.

Guided Imagery

Guided Imagery uses the “mind’s eye” to achieve the same illusion. You can do this by relaxing deeply (which in itself is known to be helpful in reducing all kinds of pain) and imagining all the sensations of the limb moving, in as much detail as you can. You can also imagine soothing pain by anything you feel might help, such as imagining a burning sensation being soothed by cool waves of water. It has been theorised that our internal mirror neurons create this helpful effect. It is a skill you can use anywhere.  

Virtual Reality

Universities are exploring how a mixture of Guided Imagery and VR may be even more effective in addressing Phantom Limb Pain.

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Phantom Pain: Causes, Symptoms, and Treatments

what is phantom pain caused by

Phantom pain refers to the phenomenon of feeling extreme, ongoing pain in a part of one’s body that is no longer there. The limb itself has been amputated, but the sensation persists. Phantom pain can be a difficult symptom to live with, and it can be hard to know what’s causing your pain. Read more to learn how many  treatment options  are available and how they can help reduce or eliminate the pain.

What is Phantom Pain?

Did you know around  80%  of the world’s amputees experience phantom pain? Phantom pain is chronic pain that occurs after an amputation or injury to the body. The term “phantom” refers to the fact that your brain continues to feel as though your body part still exists even though it has been removed. This pain can be felt in many different ways: it may feel like burning, tingling, or shooting sensations; it may be constant or intermittent; and it may occur at any time—even when you aren’t thinking about your amputated limb at all. However, it is important to seek  treatment  as soon as possible once these pains begin so they can be addressed.

What Are The Symptoms of Phantom Pain?

Phantom pain may be constant or intermittent; it may come on suddenly or come and go over time. Despite this, 8 in 10 people continue to have phantom pain two years after limb removal. The most common symptoms of phantom pain include:

  • Burning sensations
  • Aching sensations
  • Cramping sensations

You do not need to live in pain. If you are suffering from pain that could be caused by phantom pain,  we can help.

What Causes Phantom Pain?

Phantom pain is often felt soon after limb loss, but it can also come on as much as six months later and even years afterwards. The exact cause of phantom pain is unknown, but some factors are considered risk factors and can worsen pain:

  • Wearing shoes that do not provide proper arch support
  • Obesity or sudden weight gain
  • Long distance running
  • Running on uneven surfaces
  • Arch problems, including flat feet and overly high arches
  • Tight Achilles tendons

Patients who experience pain in the limb before amputation often feel phantom pains after surgery, and your  provider  will try to minimize these before you are discharged.

How is Phantom Pain Treated?

Phantom pain is a common symptom of traumatic nerve injury. The injured nerves send pain signals to the brain, even though the limb is no longer there. In some cases, these painful sensations can be treated with  medication and other therapies .

  • Medications that may help with phantom pain include opioids (painkillers) and nonsteroidal anti-inflammatory drugs (NSAIDs). Some people may also benefit from antidepressants or anticonvulsants.
  • Physical therapy may help you manage your phantom pain by teaching you how to move your unaffected limbs or use other body parts in new ways. Your provider will also work with you on activities like stretching and exercise that can reduce the intensity of your phantom pains.
  • A specially designed brace worn when you sleep may help stretch your fascia, thereby relieving pain.
  • Supportive shoes and padded inserts can also reduce the tension placed on the fascia and prevent future injury.

How Long Can Phantom Pain Persist?

Phantom pain can persist for months or even years after an injury. The length of time it takes for phantom pain to fade depends on the severity of the injury and on how you treat it.

If you treat a mild injury on time, then you should expect your phantom pain to fade within six weeks or so. If you have a more severe injury, however, then you may have persistent phantom pain for much longer—even years after the initial injury occurred.

When Should You See a Doctor for Phantom Pain?

If you’re experiencing phantom pain, you may wonder when you should see a doctor.

It’s important to note that phantom pain is not a disease or a disorder—it’s a symptom of another illness. That means that most of the time, your provider will be able to treat the underlying cause of your phantom pain without treating the pain itself.

If your pain persists for more than six months (or even longer), it can become chronic and hard to treat. When this happens, your doctor may recommend seeing a neurologist who specializes in treating chronic pain conditions.

Why Choose Clearway Pain Solutions for Treatment for Phantom Pain?

If you’re suffering from phantom pain, you know how difficult it can be to get relief. You may have tried over-the-counter remedies, at-home exercises, and even dietary or lifestyle changes, but nothing has worked. If so, it’s time to try Clearway Pain Solutions. We are the best choice for chronic pain treatment. Our team of specialists will work with you to develop a treatment plan tailored specifically to your needs. Learn more about Clearway Pain Solutions or contact us today to  schedule a consultation .

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  • Residual limb pain

Residual limb pain, sometimes called stump pain, is a type of pain felt in the part of a limb that remains after an amputation. It occurs in about half of people who have had an amputation. It may occur soon after the surgery, often within the first week, but may also last beyond healing. Residual limb pain usually isn't severe, but it may feel:

In some people, the residual limb may move uncontrollably in small or significant ways. Residual limb pain is different from phantom pain, which is pain that seems to come from an amputated limb. But residual limb pain and phantom pain often occur together. Research shows that more than half of people with phantom pain also have residual limb pain.

Residual limb pain may be caused by:

  • Problems in the bone or the soft tissue
  • Poor blood supply to the limb
  • Problems with the fit or use of a prosthesis
  • Benzon HT, et al., eds. Phantom limb pain. In: Practical Management of Pain. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2014. https://www.clinicalkey.com. Accessed Sept. 7, 2018.
  • AskMayoExpert. Amputation management (adult). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.
  • Kalapatapu V. Lower extremity amputation. https://www.uptodate.com/contents/search. Accessed Sept. 7, 2018.
  • Pain in the residual limb. Merck Manual Professional Version. https://www.merckmanuals.com/professional/special-subjects/limb-prosthetics/pain-in-the-residual-limb#v21361465. Accessed Sept. 7, 2018.
  • Freedman MK, et al. Amputation-related pain. In: Challenging Neuropathic Pain Syndromes: Evaluation and Evidence-Based Treatment. St. Louis, Mo.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Oct. 25, 2018.
  • Benzon HT, et al., eds. Postamputation pain. In: Essentials of Pain Medicine. 4th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Oct. 25, 2018.
  • Sandroni P (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 30, 2018.
  • Nerve blocks. Radiological Society of North America. https://www.radiologyinfo.org/en/info.cfm?pg=nerveblock. Accessed Nov. 6, 2018.
  • Petersen BA, et al. Phantom limb pain: Peripheral neuromodulatory and neuroprosthetic approaches to treatment. Muscle & Nerve. In press. Accessed Nov. 6, 2018.

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Phantom Pain – Causes, Types and Treatment

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Phantom pain is a pain that feels like it is coming from a body part that no longer exists. Scientists once believed this post-amputation phenomenon was a psychological  issue. But experts later recognized that these are real sensations, originating from  the spinal cord and the brain.

Introduction 

Phantom pain is a type of perception that a person experiences related to a limb or an organ of the body that is no longer a physical part of the body. Phantom pain can also arise following nerve avulsion or due to an injury to the spinal cord. These sensations are recorded most commonly following the amputation of a leg or an arm. However, they can also arise following the removal of a breast, teeth, or an internal body part.

The characteristics of phantom pain typically include:

  • Onset within the first week after amputation , although it could be delayed by months or even longer than that
  • Pain, which comes and goes or is constant
  • Symptoms affecting a limb’s part farthest from the body, such as the foot of a leg after amputation.
  • Pain that may be defined as shooting, cramping, stabbing, pins or needles, throbbing, burning, etc.

When to See a Doctor

The pain of a phantom limb often occurs shortly following amputation. It can also start months or years later. If you have undergone amputation and you are suffering phantom limb sensations, consult your doctor as soon as possible.

Call 1860-500-1066 to book an appointment.

What are the Causes of Phantom Pain?

Though the exact cause is uncertain, it seems to emanate from the spinal cord and brain. During scans like PET or MRI , the parts in the brain that had been connected neurologically to the nerves of amputated limb show some activity when the person feels phantom pain.

After amputation, areas of the brain and spinal cord also lose signals from the amputated limb and adjust to this detachment in irregular ways like pain.

Research also show that after amputation, the brain may remap that part of your body’s sensory circuitry to another part of your body. So when that part is touches, it feels as if the removed limb is being touched.

What are the Types of Phantom Pain?

There are numerous types of sensations a patient can feel. These are: 

  • Sensations that relate to the phantom limb’s posture, volume, and length: This refers to feeling that the phantom limb’s behavior is similar to a normal limb. For example, feeling the phantom limb when sitting with a bent knee or feeling that the phantom limb is heavy like the other limb. Many times, an amputee will suffer a sensation known as telescoping, the feeling that the phantom limb is slowly becoming smaller with time.
  • Sensations of movement: For example, feeling that the phantom foot is moving.
  • Sensations while touching or the sensations of temperature, pressure, and itching: Many amputees complain of feeling hot/cold, an itch, or a tingling sensation, and sometimes, pain.

In less critical cases where minor digits are amputated, the sensation can be described as a tingling feeling as opposed to a sensation of pain. Not everyone who has an amputation develops phantom pain. 

How Can You Prevent Phantom Pain?

Some doctors recommend regional anesthesia to patients as the risk of developing phantom pain is higher for those who have experienced pain in the limb before amputation. This method increases the chance of pain reduction immediately following surgery and decreases the risk of lasting phantom limb pain in the long term.

What are the Treatment Options for Phantom Pain?

There are numerous methods through which the treatment of phantom limb pain is possible. Doctors may give prescription medication to reduce limb pain. Some antidepressants or antiepileptics have been proven to have a useful effect in reducing phantom limb pain. Some physical methods such as light massage, hot and cold therapy, and electrical stimulation have often been used with variable outcomes.

There are several different treatment options for phantom limb pain presently being studied by researchers. Many treatments do not address the problem well and are therefore unsuccessful. However, some treatment options have been proven to lessen the pain in some patients. 

Some examples of medications used are:

  • Over-the-counter (OTC) pain relievers
  • Antidepressants
  • Anticonvulsants
  • Narcotics: Opioid medicines like morphine and codeine, may be an option for some people
  • N-methyl-d-aspartate (NMDA) receptor antagonists like dextromethorphan and ketamine helped relieve phantom pain 

Medical therapies

  • Mirror box: This device has mirrors that make it look like an amputated limb exists. The person can then perform symmetrical exercises while looking at the intact limb move and imagining that he/she is actually observing the missing limb moving. 
  • Acupuncture
  • Repetitive transcranial magnetic stimulation (rTMS)
  • Spinal cord stimulation
  • Brain stimulation: Motor cortex stimulation and deep brain stimulation are like spinal cord stimulation except that the current is delivered within your brain. 

Phantom limb pain arises more commonly in patients who also suffer longer periods of stump pain and is more likely to decrease as the stump pain decreases.

Frequently Asked Questions (FAQs)

Does phantom pain ever vanish.

Phantom pain eventually goes away with time. Several patients find that their pain has reduced by about 75% or more within a period of 2 years after amputation.

Why do amputated patients feel phantom pain?

Several experts believe that phantom pain may be explained partly as a response to mixed signals from the brain.

Do dogs feel phantom pain too?

They too experience discomfort and pain after a limb is lost.

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Phantom Limb Pain: Causes & Treatments

phantom limb pain

Phantom limb pain is the sensation of pain that feels like it is coming from a body part that is no longer there. Once believed to be a psychological problem, research shows that phantom limb pain is a real sensation. The sensation originates in the spinal cord and brain. 

What is Phantom Limb Pain?

Phantom limb pain is pain in an area with an amputation. The pain can be minor and go away on its own with the symptoms decreasing over time. However, phantom limb pain can be extremely debilitating and can lead to chronic pain. When the pain is consistent and continual for more than 6 months, the chances of your phantom limb pain disappearing on its own is slim-to-none. 

The pain is real and not just a psychological phenomenon. During MRI scans, areas of the brain that were previously connected to the nerves in the amputated limb show activity when the patient feel pain. 

What Causes Phantom Limb Pain?

The underlying root cause of phantom limb pain is not clear, but it originates in the spinal cord and brain. This is believed to be caused by a mixed signal in the brain. After amputation occurs, spinal cord and brain areas miss input sensations from where the limb should be. The body takes time to adjust. However, this lack of input sensations triggers the body’s most basic message that something is wrong: PAIN. 

There are studies that show how, after an amputation, the brain “rewires” that part of the body’s sensory nerves to another part of the body. Because that amputated area is unable to receive sensory information, the information is referred. This means instead of feeling pain in the now-amputated leg, you feel those senses in a still-present hand. 

Damaged nerve endings and scar tissue at the amputation site contribute to phantom limb pain. Sometimes the physical memory of the limb can invoke pain, as that sensory information has been retained. 

Treatment Options

Treatment options vary depending on the severity of the pain sensations. Like many pain conditions, a combination of multiple treatment options is most effective in reducing pain. It can be difficult to treat phantom limb pain, but your doctor may begin with medication options and noninvasive treatments. 

Some medications administered and prescribed to help phantom limb pain are as follows: 

  • Over-the-Counter Medications: Acetaminophen, Ibuprofen, or Naproxen may relieve phantom limb pain. These should be taken under the direction of your doctor. 
  • N-Methly-D-Aspartate (NMDA) Receptor Antagonists: This type of anesthetics bind to the NMDA receptors on the brain and blocks activity of glutamate – a protein that plays a crucial role in relaying nerve signals. 
  • Antidepressants : Tricyclic antidepressants may relieve the pain caused by damaged nerves. 
  • Anticonvulsants: Typically used to treat epilepsy, this medication is also used to treat nerve pain. 

Other medications may include beta-blockers, sodium channel blockers and even low-dose narcotics if the pain is severe. Many physicians do not recommend taking narcotics and find other methods of relieving pain. 

Noninvasive therapies do not always work for everyone, and just like medication, the effectiveness is monitored and measured in order to find the most viable solution to treat pain. Treatment options may involve: 

  • Acupunture: Acupuncture has been found to ease chronic pain symptoms. Long, fine, sterile needles are injected into pain points on the body, relieving tension and pain. It is an incredibly safe treatment option. 
  • Spinal Cord Stimulation: Tiny electrodes are placed along your spinal cord and an electrical current is delivered to the spinal cord and relieves pain.  
  • Heat Therapy
  • Biofeedback: Training the body to effectively handle and manage pain by learning what the sensations feel like. 
  • Relaxation Techniques: Meditation, yoga, breathing techniques, and other methods of self-taught relaxation help you learn how to focus your energy away from the pain.
  • Physical Therapy: Physical therapists design a treatment plan to incorporate cardio and strengthening exercises into your daily routine that help reduce pain and teach your body how to positively cope with pain. 

If those options do not provide effective relief, surgery is available. Talk to your doctor today about starting a treatment plan if you suffer from phantom limb pain. The experts at Precision Spine Care can help you manage your pain. Fill out the form below to get started.

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10 Causes of Pain on the Outer Side of Your Foot

Posted: January 13, 2024 | Last updated: January 13, 2024

The agony of pain on outer side of foot

Pain on the outer edge of your foot can range from annoying to debilitating.

When the stabbing, burning, or aching is severe, it can limit your ability to stand, walk, exercise, work, or engage in some of your usual activities.

Fortunately, pain on the outer footknown by doctors as lateral foot pain is not as common as other types of foot pain, including toe pain or heel pain caused by plantar fasciitis , says Kenneth Hunt, MD, an orthopedist and medical director of the UCHealth Foot and Ankle Center in Denver.

But with at least a dozen different causes, correctly identifying the source of outside foot pain can be challenging.

“The differential diagnosis for lateral foot pain is broad,” Dr. Hunt says. (These foot symptoms can reveal signs of disease.)

Causes of pain on the outer side of your foot

If your lateral foot pain does not get better with rest or starts to feel worse, it’s important to seek medical attention.

Your doctor will be able to provide you with a diagnosis and advise the best course of treatment for you.

Here are the main causes of pain on the outer side of the foot, treatment options, and how to prevent recurring foot pain.

Ankle sprains

Ankle sprains are the most common causes of lateral foot pain and are more common in people with high arches, according to Dr. Hunt.

They usually occur during activities that cause the foot to twist, roll inward, or suddenly change directionsthink basketball, volleyball, and trail running or hiking on uneven surfaces.

When the foot twists, it can cause a tear in one of the ligaments that supports the ankle bones.

How do you know if you’ve sprained your ankle? There are some key indicators: In addition to pain, you may experience swelling or bruising. And the area may be tender to the touch.

If the sprain is severe, you may hear a popping sound.

It’s important to have any ankle sprain treated promptly or it may lead to chronic instability.

“A previous ankle sprain is a risk factor for more ankle sprains,” says Dr. Hunt.

If the sprain is mild, your doctor may just recommend the RICE protocol: rest, ice, compression (with an elastic bandage), and elevation.

This should reduce the swelling and pain, though you might also need to take a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen or naproxen. In some cases, you might need crutches, a walking boot, or a brace for added support.

(Is it a sprain or a strain ? Here’s how to tell.)

Arthritis causes inflammation and pain at the joints. With 28 bones and more than 30 joints in the foot, arthritis is a common culprit of lateral foot pain.

In osteoarthritis , sometimes known as the wear-and-tear type of arthritis, the cartilage that reduces friction between bones erodes, leading to pain and stiffness.

In rheumatoid arthritis , which is an autoimmune disease , the lining that protects the joints (called the synovium) becomes swollen and eventually damages the bones, cartilage, and other supporting structures of the joint. It often begins in the foot and ankle, before moving on to other joints.

Symptoms of arthritis-related lateral foot pain include warmth and redness at the joint. Your pain may increase with activity.

You’ll need to see a physician to get an arthritis diagnosis. Your doctor will probably watch you walk, looking for bone misalignment and unusual gait patterns, and may order X-rays to look for joint deformities.

Treatment may consist of medications, like NSAIDs or steroid injections, and lifestyle changes, like switching to lower-impact forms of exercise and losing weight, if necessary.

Your doctor may recommend that you wear a brace or orthotics inside your shoes, and may suggest physical therapy to strengthen your foot muscles and increase your range of motion.

If those approaches are unsuccessful at relieving pain, you might need surgery.

Bunionettes

Sometimes called a “ tailor’s bunion ,” a bunionette is a bone malformation that causes the base of the pinky toe to jut outward.

Bunionettes can be painful, especially if too-narrow shoes rub against them. That can cause corns or calluses to form over the bony bump, which in turn creates more pressure and friction.

Usually, people find relief by wearing shoes with a wide toe boxes or the toe box can be stretched by a cobbler.

Cushioned pads that cover the bunion can alleviate pressure and help you find bunion pain relief .

Cuboid syndrome

The cuboid, a saddle-shaped bone on the outside edge at the rear of the foot, can become dislocated.

Experts don’t know the exact cause of cuboid syndrome , but they think it’s often a result of overuse, sudden injury (like an ankle sprain), or maintaining certain foot positions for long periods.

The condition is especially prevalent in ballet dancers and other athletes. People with high arches are also at higher risk.

“They tend to overload the outside of the foot and are putting increased strain on the ligaments, tendons, and bones,” says Dr. Hunt.

If your outer foot feels tight or aches, you may have cuboid syndrome.

“When [the cuboid] moves out of position, it results in tightness or stiffness,” says Dr. Hunt.

You might feel a sharp pain on the outside of your foodsometimes on the bottom too. The pain generally worsens when you stand or walk on it.

The condition is often difficult to diagnose. The cuboid bone will be sensitive to touch, but swelling is uncommon.

The issue won’t show up on an X-ray, but it may become apparent when your doctor moves your foot in different directions. Fortunately, once it’s diagnosed, treatment is fairly straightforward.

“Manipulating it back into position is the most common treatment to get it articulating correctly,” Dr. Hunt says. Steroid injections or topical NSAIDs, like diclofenac (Voltaren), can help with the pain.

You’ll also want to address structural issues that may have caused the condition in the first place.

“Orthotics and footwear changes are a mainstay of treatment,” he says. They support the outside of the foot and allow the inside of the foot to bear more of the load.

Fifth metatarsal fractures

The fifth metatarsal is the long bone on the outside edge of your foot that connects your pinky toe to your ankle.

It’s broken more often than any other metatarsal bone (the long bones that connect your ankle with your toes), accounting for more than two-thirds of metatarsal injuries , according to a 2016 study in the World Journal of Orthopedics .

The most common type of injury to the fifth metatarsal is called an avulsion fracture. It occurs when the tip of the bone closest to the ankle is pulled off by a tendon, often during an ankle sprain.

A Jones fracture, in contrast, occurs more toward the toes. It usually happens with repetitive stress or overuse, though it can also result from a new injury, particularly if an athlete’s heel is off the ground during a rapid change in direction.

The symptoms are similar for both types of fractures: The site of the injury will be tender to the touch and may have swelling or bruising.

Standing or walking might be painful. Your doctor will most likely order X-rays to determine the type of fracture, as treatments for each is quite different.

Avulsion fractures tend to heal quickly with RICE and a walking boot.

Jones fractures are harder to heal because the segment of bone they affect receives little blood supply. If you have a Jones fracture, you may need to wear a cast and use crutches for several weeks or months.

If these conservative measures don’t heal your Jones fracture, you might need surgery.

Your doctor may also recommend a course of bone stimulation , a type of therapy that uses ultrasound to promote bone repair. It can help treat the fracture whether you’ve had surgery or not.

Sinus tarsi syndrome

The sinus tarsi is a tunnel-shaped space on the outside edge of the foot between the calcaneus (heel bone) and the talus, the bone just in front of the ankle.

The sinus tarsi cavity holds numerous ligaments, nerves, and blood vessels.

If you have sinus tarsi syndrome (STS), you might develop inflammation and persistent pain on the outside/front of the ankle.

You also may experience ankle instability, especially when walking or running on uneven surfaces like hiking trails, grass, or gravel. Stiffness in the ankle is another potential sign of STS.

The cause of the condition isn’t clear. Many people report their pain starting after twisting or spraining an ankle, but up to 30 percent say no such injury occurred .

For that reason, STS is difficult to diagnose, though an MRI may show swelling, bruising, sprains, or fractures in the area.

Treatment initially consists of RICE and changes in footwear, possibly including orthotics and ankle braces. NSAIDs or steroids may help with pain.

Physical therapy will include joint mobilization exercises, balance exercises, and foot and calf stretching and strengthening. If these approaches don’t provide relief, surgery to reconstruct the ankle joint may be necessary.

Stress fractures

Stress fractures usually occur as the cumulative result of overuse, primarily in teenage and twentysomething athletes.

They also occur in people who have had a sudden increase in training, wear shoes with inadequate stability, have osteoporosis, or have a deficiency in important bone health nutrients, like vitamin D , says Dr. Hunt.

Stress fractures of the foot occur most commonly in the metatarsals and frequently near the point where the fourth and fifth metatarsals meet, though Dr. Hunt says stress fractures can also occur in the cuboid and calcaneus (heel) bones.

Usually, he says, there’s a point of tenderness right on the bone that’s been fractured, but your doctor will often order an MRI to confirm it.

Because stress fractures develop progressively, they often require surgery to repair by the time they are seen in a doctor’s office.

Tendinopathies

The term tendinopathy refers to any injury to a tendon, the fibrous cord that connects muscle to bone.

This can include tendinosis, a degenerative process in the tendon, and tendinitis, an inflammation or irritation resulting from overuse or a sudden increase in activity, which is easily seen on ultrasound or MRI.

Tendinitis is much more common9 percent of the people in a 2018 American Podiatric Medical Association survey reported experiencing itand it can affect the foot in several ways.

Both Achilles tendinitis and peroneal tendinitis can cause pain on the outside of the foot.

Achilles tendinitis

The Achilles tendon is the largest and strongest tendon in the body, attaching the calf muscles to the heel bone.

While an injury to this tendon usually results in pain at the back of the heel, Dr. Hunt says it can also lead to lateral foot pain.

Treatment generally consists of RICE, followed by stretching exercises for the calf muscles. Physical therapy may include eccentric strengthening exercises that focus on lengthening the involved muscles.

Peroneal tendinitis

There are two peroneal tendons, which run behind the lateral malleolusa fancy term for the outer knob-like ankle boneand along the back of the fibula (shin bone).

These include the peroneus brevis and the peroneus longus, which turn the ankle toward the outside and help point the toes.

Injuries to the peroneal tendons are common; in fact, Dr. Hunt says it’s the second most common cause of lateral foot pain he sees.

One clue your pain is from peroneal tendinitis? The pain comes on gradually.

It can affect the outside of the foot and ankle, and possibly the outside of your leg. The pain may be worse when you try to turn your foot outward against resistance or flex it upwards.

Another sign: the tissue behind your ankle bone may be tender or swollen.

Long-distance runners and other athletes with tight calf muscles are commonly affected, though the condition can also arise in people who have a muscular imbalance, high arches, or a previous ankle injury.

The treatment generally consists of RICE and footwear changes. Both orthotics and heel wedges can help.

If your pain is severe, your doctor may recommend a walking boot or ankle brace. There’s a good chance that ankle-strengthening and stabilizing exercises will be included in your recovery program.

Newer treatments include shockwave therapy, platelet-rich plasma injections, and nitroglycerin patches, all of which may potentially stimulate a healing response. Anecdotally speaking, doctors say they’re often effective.

But Dr. Hunt says not to expect miracles.

Most of the research on these technologies has been done on the Achilles tendon, not the peroneal tendons.

“The theory is good, but there’s not a lot of evidence in the literature” that supports using them for this kind of injury, he says.

Painful os peroneum syndrome (POPS)

About 20 percent of people have an os peroneum, a tiny accessory bone that sits within the peroneus longus tendon. And most of the time, it does not cause any discomfort.

But if the bone fractures, or the peroneus longus tendon is tears or gets trapped near the bone (sometimes from an ankle injury), you can have considerable pain. No surprisethe word painful is right there in the name.

Up to 60 percent of the time, the condition will affect both feet. Like peroneal tendinitis, POPS can cause outside foot and ankle pain, swelling, and tenderness, as well as difficulty turning the foot outward or pointing the toes downward.

You’ll typically treat the condition the same way you’d treat peroneal tendinitis: RICE, orthotics and/or heel wedges, and possibly an ankle brace or walking boot. If conservative approaches are unsuccessful, your doctor may recommend surgery.

Tarsal coalition

This painful condition is one you may have been born with. It happens when two bones at the back of the footusually the calcaneus and navicular bones or the calcaneus and talus bonesare fused together, either before birth or due to arthritis or an infection.

The result is a flat foot and rigid ankle that is easily sprained.

Symptoms often don’t appear until adolescence. Once the condition is diagnosed, it’s usually treated with pain medications, orthotics, and physical therapy.

If those therapies don’t work, you might need surgery.

Preventing outer-side-of-foot pain

The best way to prevent lateral foot pain, is to protect your feet. Since poorly fitted shoes can lead to some of the conditions that cause pain on the outer side of the foot, consider new kicks.

Dr. Hunt suggests replacing athletic shoes after every 300 miles.

If you’re an athlete, start new sports slowly, and gradually increase your time, speed, and distance. And add lower-impact activities into your training regimen. For example, he says, “switch running with swimming or biking.”

He also recommends strength training, along with a healthy diet packed with plenty of calcium and vitamin D , which will help prevent early muscle fatigue and keep bones strong. And always see your doctor if you have a persistent area of concern or discomfort.

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The post 10 Causes of Pain on the Outer Side of Your Foot appeared first on The Healthy .

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  • v.12(3); 2022 Mar

Unveiling the phantom: What neuroimaging has taught us about phantom limb pain

Jonathan d. browne.

1 School of Medicine, California University of Science and Medicine, Colton California, USA

Ryan Fraiser

2 Center for Pain Medicine, University of California San Diego, La Jolla California, USA

Dillon Leung

3 College of Letters and Science, University of California Berkeley, Berkeley California, USA

Albert Leung

Michael vaninetti.

Phantom limb pain (PLP) is a complicated condition with diverse clinical challenges. It consists of pain perception of a previously amputated limb. The exact pain mechanism is disputed and includes mechanisms involving cerebral, peripheral, and spinal origins. Such controversy limits researchers’ and clinicians’ ability to develop consistent therapeutics or management. Neuroimaging is an essential tool that can address this problem. This review explores diffusion tensor imaging, functional magnetic resonance imaging, electroencephalography, and magnetoencephalography in the context of PLP. These imaging modalities have distinct mechanisms, implications, applications, and limitations. Diffusion tensor imaging can outline structural changes and has surgical applications. Functional magnetic resonance imaging captures functional changes with spatial resolution and has therapeutic applications. Electroencephalography and magnetoencephalography can identify functional changes with a strong temporal resolution. Each imaging technique provides a unique perspective and they can be used in concert to reveal the true nature of PLP. Furthermore, researchers can utilize the respective strengths of each neuroimaging technique to support the development of innovative therapies. PLP exemplifies how neuroimaging and clinical management are intricately connected. This review can assist clinicians and researchers seeking a foundation for applications and understanding the limitations of neuroimaging techniques in the context of PLP.

1. INTRODUCTION

Pain is unique to individuals who experience it, and the subjective nature of pain challenges its fundamental understanding. Phantom limb pain (PLP) is one such clinical mystery for researchers, clinicians, and patients. While PLP phenomenon has been well documented in recent history, the underlying pathophysiology was poorly understood due to limitation in investigational tools. Ambroise Paré described patients feeling absent limbs following amputations he performed during the 16th century, and in the 17th century, philosopher René Descartes concluded that there might be a dissociation between nerve signals and cognitive interpretation in amputees (Finger & Hustwit, 2003 ). Later, during the American Civil War, surgeon Silas Weir Mitchell was frustrated by ineffective treatments for PLP and became notable for advocating formal scientific investigations (Finger & Hustwit, 2003 ). This mystery continues to draw curiosity and interest, and it now leverages modern technology to uncover its truth.

More than merely quenching scientific curiosity, further PLP research is needed to improve the lives of amputees. The amputee population in America is estimated to increase from 1.6 million in 2005 to 3.6 million by 2050 (Ziegler‐Graham et al., 2008 ). PLP, which is the pain of the amputated limb that is variable in timing, is experienced by up to 79.9% of amputees (Ehde et al., 2000 ; Ephraim et al., 2005 ). The severity of phantom limb sensations ranges from nonpainful to disabling and, in some instances, can be physically and psychologically debilitating (Ephraim et al., 2005 ). For surgical amputees, chronic preoperative pain and acute postoperative phantom pain are risk factors for PLP (Hanley et al., 2007 ; Larbig et al., 2019 ). Still, correlations for the severity of pain have been inconsistent (Sherman et al., 1984 ). These variations in the clinical presentation of PLP continue to burden amputees, warranting a deeper understanding of its mechanism to improve diagnosis and efficacious clinical approaches. As the demand for a conclusive understanding grows, so does the controversy among scientists and clinicians.

PLP is a particularly challenging syndrome to diagnose and treat, which may be related to the fact that, by mechanistic nature, it is challenging to understand. Nonspecific and highly varied symptoms can make diagnosing PLP difficult, requiring a comprehensive history, examination, tests, and exclusion of other possible neuropathies (Ferraro et al., 2016 ). The variety of PLP therapies, including pharmacologic, cranial stimulation, and sensory therapies, have been inconsistent (Aternali & Katz, 2019 ; Richardson & Kulkarni, 2017 ) with some potential being demonstrated among integrative approaches (Subedi & Grossberg, 2011 ). These challenges parallel the equally complex range of mechanistic explanations of PLP, which involve various combinations of cerebral, spinal, and peripheral nervous system pathologies (Flor et al., 2006 ). These mechanistic, diagnostic, and management inconsistencies underscore the importance of foundational tools for analyzing PLP. Due to the brain's role in interpreting, processing, and modulating pain, neuroimaging may fulfill this need. In addition to aiding understanding of PLP, neuroimaging may assist the development of PLP therapies.

This article will review current noninvasive imaging modalities for PLP research in mechanistic and therapeutic investigations. It will focus on diffusion tensor imaging (DTI), functional magnetic resonance imaging (fMRI), electroencephalography (EEG), and magnetoencephalography (MEG). Researchers and clinicians utilize each imaging modality in distinct ways to complement dynamic research involving diagnosing, characterizing, and treating PLP. By examining how DTI, fMRI, EEG, and MEG have impacted the understanding of PLP, we aim to summarize a baseline of fundamental imaging techniques to foster further research.

1.1. Background on potential pain mechanisms

In order to understand the impact of the major imaging modalities used in this field, it is helpful to briefly review the prevailing discussed potential mechanisms behind PLP. In the properly functioning human nervous system, peripheral noxious stimulus generates a sensation of pain via a cascade of neuronal events. The pathway consists of primary afferent pain fibers which carry the afferent signals from the peripheral nociceptors to the spinal cord where they synapse directly or indirectly via interneuron with the secondary neurons at the dorsal horn of the spinal cord. The afferent signals then ascend via the second‐order neurons to the brain via either spinothalamic or spinoreticular tracts (Steeds, 2009 ). Passage of this nociceptive information through the brainstem triggers modulatory signals back through the dorsal horn. These modulatory signals alter primary afferent neuron propagation which can facilitate or inhibit further peripheral nociceptive information (Renn & Dorsey, 2005 ). Additionally, supraspinal pain signal processing and modulation are important for healthy pain perception. First, the thalamus and pons relate afferent sensory signals to other supraspinal regions. Other supraspinal groups include the somatosensory cortices and inferior parietal lobe, anterior cingulate cortex (ACC) and insula (IN), and dorsolateral prefrontal cortex, which are also important sensory discriminatory, affective, and modulatory regions, respectively (Leung, 2020 ). Furthermore, supraspinal modulatory functional connectivity deficits have been associated with white matter tract deficits, emphasizing the vital role of supraspinal processing (Leung et al., 2016 , 2018 ). These normal pain mechanisms involve the intricate relationship between peripheral, spinal, and supraspinal regions.

PLP draws attention because there is still no consensus on its mechanism. Cerebral, spinal, and peripheral explanations each bear scientific evidence, perpetuating the controversy (Collins et al., 2018 ). Mechanisms within these groups are not mutually exclusive and PLP may be explained by some combination. Furthermore, researchers speculate if PLP may be a cluster of pain disorders, rather than a single disorder (Griffin & Tsao, 2014 ). Researchers have prioritized this mechanistic puzzle as it is essential for providing quality care to these patients.

Cerebral mechanisms consist of cortical reorganization, alterations in sensory and motor feedback, and pain memory (Flor et al., 2006 ). PLP is commonly correlated with reorganization and furthermore related to the self‐perception of one's own body (Subedi and Grossberg, 2011) . In support of cerebral mechanisms, a 1998 study found hemispheric differences in cortical representation in traumatic amputees absent in subjects with congenital absence of limb (Montoya et al., 1998 ).

Spinal mechanisms relate to amputation‐related nerve injury causing spinal cord hypersensitization and further reorganization of spinal cord areas formerly occupied by functioning afferent nerves (Flor et al., 2006 ). Connections between the proximal sections of amputated nerves can form disruptive connections with receptive spinal nerves. Additionally, distorted neuronal activity, hyperexcitability, and central nociceptive neuron firing pattern changes may also contribute to PLP (Subedi and Grossberg, 2011) .

The peripheral mechanisms involve nerve ending and dorsal root ganglion reorganization following amputations (Flor et al., 2006) . Efficacious pre‐ and postoperative peripheral interventions for PLP support this explanation. Patients receiving peripheral nerve interfaces before surgery have had lower rates of peripheral neuromas and PLP (Kubiak et al., 2019 ). Additionally, minimally invasive percutaneous peripheral nerve stimulation programs improved functionality in patients with chronic pain postamputation (Gilmore et al., 2019 ). Peripheral nervous system treatment has addressed PLP functionality and pain, which validates this mechanism.

Cerebral, spinal, and peripheral PLP mechanisms have each endured scientific evaluation with no distinct victor. These are also not mutually exclusive and PLP may be a product of a combination of these mechanisms. Makin and Flor further expand upon the multifactorial nature through a review of factors beyond remapping that may come together to contribute to PLP (Makin & Flor, 2020 ). Broad consideration of mechanism and dynamic changes warrants a comprehensive analysis of this complex disease. Investigators continue to explore this scientific question using several specialized neuroimaging techniques.

A literature search was conducted using the PubMed database between January 2020 and August 2021. The literature search was organized using the following keywords/keyword combinations: “phantom limb pain and diffusion tensor imaging (DTI),” “phantom limb pain mechanism,” “phantom limb pain and electroencephalography (EEG),” “phantom limb pain and functional magnetic resonance imaging (fMRI),” “phantom limb pain and amputation,” “phantom pain,” “phantom limb pain and mirror therapy,” “phantom limb pain and magnetoencephalography (MEG),” “phantom limb pain and therapeutics,” “diffusion tensor imaging (DTI),” “electroencephalography (EEG),” “magnetoencephalography (MEG),” “functional magnetic resonance imaging (fMRI).” The articles generated from the search were then screened and additional articles referenced by the searched articles were also utilized. Articles were selected based on the inclusion of amputees with PLP or phantom sensations along with the utilization of DTI, fMRI, EEG, or MEG to investigate mechanism or response to therapy.

3.1. Diffusion tensor imaging

DTI is a variant of conventional MRI that has become a standard tool in researching PLP. As a general MRI principle, tissue microstructure determines water diffusion, which translates into an image. Anisotropy describes water diffusion that is directionally dependent while isotropy describes unrestricted water diffusion; white matter is more anisotropic than gray matter, while cerebrospinal fluid is isotropic (Hagmann et al., 2006 ; Pierpaoli et al., 1996 ). DTI capitalizes on white matter tracts to assess structural integrity and connectivity (Bandettini, 2009 ). In PLP, DTI has become the most common tool for evaluating anatomical changes.

Important DTI scalars include axial diffusivity (AD), radial diffusivity (RD), mean diffusivity (MD), and fractional anisotropy (FA). AD and RD characterize rates of diffusion in principal and perpendicular directions, respectively, while MD is the net displacement of water molecules (Feldman et al., 2010 ). FA is a ratio that describes the degree of anisotropic diffusion (Feldman et al., 2010 ). These scalars allow DTI to interpret structural changes within the brain. A 2019 study employed DTI to determine a connection between PLP and white matter changes. Interestingly, these researchers found symmetrically increased white matter AD bilaterally, but a stronger white matter RD association with visual analog scale (VAS) score in the corpus callosum and hemisphere associated with the amputated limb (Seo et al., 2019 ). Guo et al. ( 2019 ) studied changes in FA following upper‐limb amputation using DTI and positively correlated contralateral middle temporal gyrus nodal strength with the magnitude of PLP. In contrast, Jiang et al. studied lower‐limb amputees using DTI and described ipsilateral decreased FA in the superior corona radiata, sub‐temporal lobe white matter, and inferior fronto‐occipital fasciculus. Additionally, they noted contralateral reduced FA in the left premotor cortex. Utilizing tractography in the premotor cortices, they also found altered interhemispheric fibers (Jiang et al., 2015 ).

Structural analysis is useful for understanding physical changes due to PLP and potentially planning for interventions. The properties of DTI have propelled it to become a standard tool for such structural analysis. Corpus callosum changes identified via DTI provide clues regarding the connection between phantom sensations and sensorimotor cortex inhibition (Simões et al., 2012 ). Furthermore, Owen et al. ( 2007 ) utilized DTI tractography to guide deep brain stimulation in an amputee experiencing stump pain. DTI applications and key findings are summarized in Table  1 .

Diffusion tensor imaging (DTI) and phantom limb pain (PLP)

Note : Study sample size reflects amputees with phantom limb pain unless otherwise noted.

a Amputees with “painless” phantom sensations.

Despite its growing prevalence in neuroimaging, DTI maintains technical issues such as subject motion, eddy currents, and low resolution (Bandettini, 2009) . A review of DTI imaging by Alexander et al. found that its measure of FA was sensitive for finding microstructure changes, but this alone was less useful for characterizing such changes. They emphasized the importance of utilizing additional DTI scalars in concert for comprehensive cerebral pathology classification (Alexander et al., 2007 ). Hakulinen et al. caution the acceptance of FA, considering it to be nonspecific to various pathologies. They also note the variation in the DTI technique, potentially compromising different reports’ comparability without a validated method. The review concludes that the circular method has better repeatability, while the freehand method has less variation; these characteristics may be advantageous for studying distinct aspects of the brain (Hakulinen et al., 2012 ). Furthermore, Soares et al. ( 2013 ) address the technical components of DTI interpretation at each stage of data collection and propose conformity that may serve to reduce variability among researchers.

In summary, DTI exploits water diffusion due to tissue microstructures to reveal critical structural changes due to PLP. As depicted in Figure  1 , analysis of these structural changes can contribute to studying cerebral mechanisms of PLP. Technical aspects limit this imaging technique and may compromise data collection and interpretation. DTI should continue to be used to characterize how particular structural changes relate to the presence and severity of PLP in correlation with functional changes.

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Flowchart of imaging modalities within the context of phantom limb pain.

3.2. Functional magnetic resonance imaging

fMRI employs many of the same concepts as DTI. However, in contrast to DTI structural imaging, fMRI is an essential functional imaging technique utilized in PLP research. Magnetic forces create particular arrangements of water molecules. Additionally, oxyhemoglobin and deoxyhemoglobin have different magnetic properties (Bunge & Kahn, 2009 ). Thus, fMRI can measure tissue perfusion and changes in oxygen that are interpreted to create a functional activity map (Logothetis, 2008 ). It is a commonly used neuroimaging technique due to logistic factors such as availability, low cost, and low risks (Bunge and Kahn, 2009) . Compared to the other functional imaging techniques discussed in this review (EEG and MEG), fMRI has more substantial spatial resolution but lower temporal resolution (Meyer‐Lindenberg, 2010 ).

Simoes et al. ( 2012 ) combined fMRI and DTI to study cortical and colossal plasticity and found that neuroplastic modifications were present in subjects who reported PLP and those who reported only phantom limb sensations . Pasaye et al. ( 2010 ) also utilized fMRI to show activation of distinct areas within the brain upon stump stimulation. Andoh et al. ( 2017 ) identified inter‐ and intrahemispheric differences in amputees via fMRI in addition to bilateral SI and intraparietal sulcus activation upon phantom sensation evocation. In a later study, Andoh et al. (2020) also utilized fMRI during a virtual reality (VR) task to demonstrate that motor cortex activity was positively related to PLP intensity.

When characterizing the efficacy of PLP rehabilitative techniques, researchers often utilize fMRI. Foell et al. focused on fMRI to identify physical changes in response to mirror therapy, which involved movement of the intact limb in front of a mirror to create the perception of movement in the amputated limb. They report decreased inferior parietal cortex activity and the reversal of maladaptive cortical reorganization (Foell et al., 2014 ). In a case report about using chronic motor cortex stimulation to treat PLP, researchers used fMRI for precise surgical electrode placement and monitored the patient's response to therapy (Roux et al., 2008 ). A study of 13 upper limb amputees utilized fMRI that showed reduced cortical reorganization in PLP patients following mental imagery therapy by contrasting pretraining diffuse cortical activation upon motor tasks, such as a lip purse, with post‐training isolated lip area activation. This 6‐week training additionally correlated reductions in pain intensity with a decrease in cortical reorganization (MacIver et al., 2008 ). fMRI applications and key findings are summarized in Table  2 .

Functional magnetic resonance imaging (fMRI) and phantom limb pain (PLP)

Logothetis explains that fMRI interpretation requires caution as this neuroimaging technique may not make key distinctions, such as top‐down versus bottom‐up, excitation versus inhibition, or regional differences (Logothetis, 2008 ). Another recent review of 10 fMRI investigations from 2001 to 2015 found that this imaging technique did not comprehensively support maladaptive brain plasticity, including the relationship between pain intensity and reorganization (Jutzeler et al., 2015 ). In studying fMRI during a VR movement task, Andoh et al. (2020) found that fMRI findings for PLP may vary based on methodology. These findings suggest that fMRI is inconsistent in evaluating changes due to PLP, or perhaps there are gaps in understanding of plasticity in PLP. This principle reiterates the importance of the link between PLP and neurologic adaptation and the need for collaborative techniques.

fMRI measures functional changes with strong spatial resolution but is prone to certain ambiguities in interpretation. The lack of critical distinctions may be why fMRI studies have shown mixed results in PLP research. fMRI has utility in supplementing studies of PLP therapies and interventions (Figure  1 ).

3.3. Electroencephalography

EEG is a temporal‐functional imaging technique that is useful in PLP research. EEG interprets electrical flow across membranes as neurons depolarize. It is distinct from the other imaging techniques discussed in this review by recording real‐time measurements in varying cognitive states (Bunge and Kahn, 2009) . By measuring perpendicular electrical flow, EEG can analyze gyri and deep sulci pyramidal cells (Bunge and Kahn, 2009) . EEG has been further touted, along with MEG, as a method of analyzing cortical reorganization due to advantageous temporal and spatial resolution (Wiech et al., 2004 ). Other researchers have challenged EEG and MEG for truly assessing signal sources, and suggest employing fMRI as a tertiary, complementary component for signal localization (Bunge and Kahn, 2009 ; Cottereau et al., 2015 ). EEG, along with MEG, has higher temporal resolution but lower spatial resolution than fMRI (Meyer‐Lindenberg, 2010 ). The unique ability to perform EEG simultaneously with fMRI further distinguishes this tool as a select method for capturing nonrepeatable events (Bandettini, 2009) .

A case report of a subject with a congenitally absent limb found EEG signatures during attempted movements of the phantom limb to be similar to a cohort of healthy volunteers (Walsh et al., 2015 ). Another study analyzed a cohort of 22 right‐hand amputees via EEG showed distinct global and local network changes in alpha and beta bands (Lyu et al., 2016 ). An investigation of the connection between pain catastrophizing and PLP using EEG showed that these patients had an increased response at the N/P135 dipole of the affected side, suggesting that attention to stimuli may be associated with PLP (Vase et al., 2012 ).

Mirror therapy has been studied as a potential PLP treatment, but recent developments in VR have enabled inventive therapeutic techniques. One such VR investigation utilized EEG and observed PLP alleviation and alpha wave coherence during stimulation of referred sensation areas (Osumi et al., 2020 ). EEG presents a safe and practical way to monitor the forefront of therapeutic techniques for PLP. It allows researchers to gather robust functional change data during therapies. EEG applications and key findings are summarized in Table  3 .

Electroencephalography (EEG) and phantom limb pain (PLP)

While it has many applications and strengths, EEG is limited by lower spatial resolution than fMRI (Meyer‐Lindenberg, 2010) . The spatial resolution has important utility in the investigation of cerebral PLP mechanisms. If only certain superficial regions are reliably captured, deeper cortical reorganization may be missed. Additionally, a review of the EEG technique concluded that EEG deflections are challenging to interpret, and this tool should be one of many used in conjunction (Jackson & Bolger, 2014 ). EEG alone therefore may not provide adequate information about functional changes due to PLP.

EEG is one of the two main techniques for identifying functional changes with temporal resolution. It measures changes in electrical potential perpendicular to the direction of neuronal signal propagation. While EEG is limited by a lack of spatial resolution, its inherent design allows it to be easily used alongside other tools to provide comprehensive results. EEG is a practical way to monitor functional changes while developing PLP therapies (Figure  1 ).

3.4. Magnetoencephalography

MEG is another temporal‐functional imaging technique used in PLP research. It functions by measuring the small magnetic fields created by electrical currents involved in neuronal signaling. The measured magnetic dipole is 90° off phase with the electrical one. The electrical and magnetic fields detected by EEG and MEG are generated by extracellular and intracellular currents, respectively (Singh, 2014 ). Both of these measured phenomena occur at directions perpendicular to that of neuronal signal propagation. Because it assesses magnetic activity at and parallel to the brain's surface, MEG is limited to the analysis of superficial sulci pyramidal cells (Bunge & Kahn, 2009) . As mentioned before, EEG and MEG share a common caveat as they both have difficulty localizing signal sources (Bunge & Kahn, 2009) . MEG also has a higher temporal resolution but lower spatial resolution compared to fMRI (Meyer‐Lindenberg, 2010) .

In a 2001 study, researchers induced acute left thenar pain in healthy non‐PLP patients through capsaicin injections. MEG analysis revealed increased proximity between hand and lip representation, suggesting an acute reorganization in response to the stimulus (Sörös et al., 2001 ). Blume et al. later utilized MEG and identified lip and hand cortical reorganization following an amputated limb replantation. In contrast to other reports, they also found a negative correlation between pain and cortical reorganization (Blume et al., 2014 ).

Kringelbach et al. employed MEG to investigate the effect of deep brain stimulation on a PLP patient. The researchers found changes in mid‐anterior orbitofrontal and subgenual cingulate activity after stimulation was stopped and associated these regions of the brain with pain relief. Their results demonstrate that MEG is useful for identifying response to therapy and potential surgical targets for pain relief (Kringelbach et al., 2007 ). Another investigation of brain–machine interface training integrated MEG reading with a robotic hand. Interestingly, they found this training to intensify pain when used with the phantom limb. At the same time, it reduced pain during dissociative prosthetic‐phantom hand training, further suggesting a link between plasticity and pain (Yanagisawa et al., 2016 ). MEG applications and key findings are summarized in Table  4 .

Magnetoencephalography (MEG) and phantom limb pain (PLP)

Despite its usefulness and safety, MEG has sensitivity to artifacts. Ray et al. addressed the challenge of deep brain stimulation artifact when using MEG by focusing on the occipital lobe following a visual stimulus (Ray et al., 2009 ). The study shows that this tool can provide relevant information if researchers account for its limitations.

MEG is another primary technique for identifying functional changes with temporal resolution. In contrast to EEG, MEG detects magnetic activity parallel to the brain surface. This imaging modality is mostly limited by potential artifacts, which an adapted approach may control. MEG has promising future use for studying robotic and interventional therapy in PLP research (Figure  1 ).

4. DISCUSSION

Neuroimaging has proven paramount in the study of PLP (Figure  1 ). DTI readily outlines structural changes and has potential for surgical applications but is frequently cited for technical limitations, such as subject motion and resolution. Additionally, DTI has often been criticized for variation in measuring technique and data interpretation. fMRI captures functional changes with spatial resolution in various PLP therapies, but cannot make critical neurologic distinctions, which limits data interpretation without behavioral or structural correlation. EEG and MEG are notable for identifying functional changes with a strong temporal resolution and are differentiated by perpendicular electric and parallel magnetic activity, respectively. EEG is significant for spatial limitations, while both EEG and MEG are limited by artifact. Overall, all four imaging techniques provide unique perspectives that have shaped the modern understanding of PLP.

Accessibility and practicality are common barriers that limit PLP neuroimaging. The study scale is often resource dependent, which has restricted how much imaging data can be collected. Limited reproducibility of neuroimaging findings may also hinder the analysis of PLP in certain cases. Consistent techniques and collaboration may alleviate the burden on groups studying PLP. Additionally, the automation of imaging analysis using artificial intelligence and machine learning algorithms may generate uniformity among data interpretation (Hu et al., 2019 ; Vieira et al., 2017 ). These advancements enable the synthesis of data sets to help map neural changes. Robust data collection illustrates the key intersection of imaging and analytical technology, especially in the context of clinical disease. As this field evolves, researchers will continue to utilize neuroimaging aiming to provide fundamental insight into PLP's pathogenesis and treatment.

FUNDING INFORMATION

Conflict of interest.

The authors declare no conflict of interest.

PEER REVIEW

The peer review history for this article is available at https://publons.com/publon/10.1002/brb3.2509

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Dear Doctor: What is neuropathy of the feet and what tests are needed?

  • Published: Jan. 08, 2024, 6:01 a.m.

Dr. Keith Roach

Dr. Keith Roach is a physician at Weill Cornell Medical College and New York Presbyterian Hospital. He writes an educational column on infectious diseases, public health and sports medicine. North America Syndicate

  • Dr. Keith Roach

DEAR DR. ROACH: My daughter and her friend went to a concert and had to climb stairs, walking about 2.5 miles in total. After returning home, my daughter had severe pain in both of her feet and was unable to stand or walk on them. She said it felt like someone was crushing them.

The pain did not get better, so she went to an emergency room a few days later. A doctor there performed an X-ray and said that the pain was due to bunions, although the doctor did not even look at her feet. She also saw a foot specialist, who told her that the diagnosis was neuropathy of the feet and recommended Neurontin for pain. He asked her if she has diabetes, but she does not. They told my daughter that she will have to live in pain for the rest of her life.

The doctor recommended some tests on her nerves at the hospital, but she doesn’t have money to pay for these tests. What can be done to help her? How is it possible that the pain started so suddenly? She is in constant pain and is unable to walk. -- K.B.

ANSWER: “Neuropathy” is not a diagnosis; it’s a name for a diverse group of diseases that cause damage to the nerves and may signify nerves of the brain and spinal cord, or those outside.

The idea of getting nerve testing done is correct. This does sound like neuropathy from the little bit of information I have, although neuropathies do not typically begin with exercise the way you described. I have seen several cases where muscles have become terribly inflamed and even break down after a period of unusually strenuous exertion (this usually gets better with time), but I would have expected the doctors to make that diagnosis.

There is a compressive neuropathy in the foot (tarsal tunnel syndrome) where the nerve is damaged by pressure from muscles, bones and connective tissue, but for that to happen with both feet at the same time would be surprising. Metabolic neuropathies, like B12 deficiency, cause symptoms on both sides but do not begin suddenly. I’d be worried about the lower spine.

I don’t know what your daughter’s financial situation is, whether she might be eligible for Medicaid or the Affordable Care Act, or whether there is a free medical clinic near you. I have had many patients make just enough money that they don’t qualify for Medicaid but can’t afford commercial insurance and don’t get it through work.

DEAR DR. ROACH: What is your opinion of laser therapy for joint pain? What are the risks and benefits? -- M.J.

ANSWER: Low-level laser therapy, sometimes called cold laser, is thought to improve circulation, lessen inflammation and decrease pain sensitivity when applied to the skin over a joint with osteoarthritis, such as the knee.

In several reviews of small studies, laser treatment provides a modest benefit in decreasing pain, disability and stiffness when compared to a treatment that appeared the same to the participant but did not use the same kind of laser. (In the most stringent studies, even the person using the laser didn’t know whether it was set to the effective treatment or not.) Muscle strength was also increased. In these studies, no adverse effects were noted.

However, this therapy is still regarded as experimental, so it is not usually covered by insurance. Generally, insurance companies will cover treatments once enough evidence accumulates to prove them effective.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.

(c) 2022 North America Syndicate Inc.

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Causes of Lower Left Abdominal Pain

What is lower left abdominal pain, when to see a healthcare provider, diagnosing causes of lower left abdominal pain.

Lower left abdominal pain can be caused by a wide variety of conditions that affect the organs and structures in that area, which contains parts of the digestive system, urinary system, and reproductive organs.

Lower left abdominal pain can be benign (harmless) or a sign of a serious illness. Hernias, kidney stones, and endometriosis are some common causes of pain in this region. In some cases, the cause may be cancer.

This article will review the causes of lower left abdominal pain, how it is diagnosed and treated, and when to see a healthcare provider or get immediate care.

Moyo Studio / Getty Images

The lower left of the abdomen is the area on the left side of your abdomen, underneath your belly button.

Pain in this area may be acute (of short duration) or chronic (lasting more than six months). Lower left abdominal pain can feel different depending on what's causing the discomfort. The pain can be:

  • Superficial

Since several organs occupy the lower left abdominal space, there could be many causes for pain in this area. Potential reasons for lower left abdominal pain include digestive , urological, gynecologic , infectious, and structural conditions, including:

  • Irritable bowel syndrome (IBS)
  • Left-sided kidney stones
  • Endometriosis

Small Intestine and Colon Conditions

The small intestine and colon take up a large portion of the lower left abdomen. Some small intestine and colon disorders can cause lower left abdominal pain, including:

  • Irritable bowel syndrome (IBS): A functional gastrointestinal disorder that results in abdominal pain, cramping, and diarrhea.
  • Colitis : Infections, immunotherapy treatment for cancer, and food allergies can cause the colon to become inflamed and painful.
  • Ischemic colitis : This condition interrupts blood flow to the large intestine. A lack of blood flow can cause the bowel tissue to die, which is a painful medical emergency.
  • Inflammatory bowel diseases (IBD): Crohn's disease , ulcerative colitis , and indeterminate colitis are chronic disorders that cause bowel changes and pain.
  • Diverticulitis : A large intestine condition resulting in painful, inflamed, and/or infected intestinal pockets or pouches.
  • Colon cancer : A tumor in the colon can cause intestinal blockage, constipation, diarrhea, and pain.

In addition to lower left abdominal pain, these conditions can cause bowel changes, indigestion , gas, bloating , nausea, and vomiting.

Urological Conditions

The urinary tract consists of the kidneys, ureters, urethra, and bladder. Certain disorders of the urinary tract can cause lower left abdominal pain, including:

  • Left-sided kidney stones: Kidney stones try to exit through the ureter, urethra, and bladder. Pain and discomfort can be felt in the back and lower left abdomen.
  • Kidney or bladder infection: These conditions can lead to irritation, inflammation, and pain.
  • Left ureter malfunction: A blockage of the left ureter can decrease the ability for urine to pass from the kidney to the bladder, resulting in pain.
  • Cancer of the urinary tract: A tumor in any part of the urinary tract can grow over time, causing urological dysfunction and pain.

If you are experiencing lower left abdominal pain, decreased urine output, and hematuria (blood in the urine), you should be evaluated by your healthcare provider immediately.

Gynecologic Conditions

Lower left abdominal pain in people with female reproductive organs can signify a serious medical condition that may require emergency treatment. Causes include:

  • Ectopic pregnancy : When a fertilized egg grows in a fallopian tube, it can rupture, causing severe abdominal pain, shoulder pain, and bleeding.
  • Endometriosis: Swelling, bleeding, and pain can happen if uterine lining cells travel outside the uterus and begin growing on other organs, like the left ovary.
  • Left ovarian cyst : These fluid-filled sacs in or on the ovary can become very large, painful, and even rupture. There's also a risk of an ovarian torsion , as well.
  • Pelvic inflammatory disease: Inflammation and irritation of reproductive organs can be caused by an untreated sexually transmitted infection (STI).
  • Cancer of the reproductive system : A growing tumor within the uterus, fallopian tube, or ovary can cause pain that radiates to the lower left abdomen.

Abdominal pain accompanied by blisters or a red, scaly skin rash located only on the left abdomen could be shingles, a viral infection affecting the nerves, causing intense pain. You may also experience fever, chills, nausea, and headache. You may need specific medication to reduce nerve pain. If you are 50 or older, you can be vaccinated against the virus.

Structural Conditions

A hernia occurs when an organ, such as the colon, pushes through a weak spot in the abdominal wall, causing a bulge. Hernias are common in the abdomen and inguinal (groin) area. Some hernias are not painful or disruptive, but others may require surgical repair to improve symptoms.

Make an appointment to see your health provider if you experience any of the following symptoms along with abdominal pain:

  • Blood in your urine
  • Blood in your stool
  • Unexplained weight loss

Symptoms requiring emergency medical attention include abdominal pain accompanied by:

  • Shaking chills
  • Change in mental status (such as confusion)
  • Pain that is severe, progressive, or persistent.

Depending on the type of symptoms you're experiencing, a healthcare provider may use several methods to diagnose the cause of lower left abdominal pain.

  • Physical exam: Your healthcare provider will also review your family history.
  • Bloodwork : Blood tests can provide clues to a possible diagnosis.
  • Imaging: Computerized tomography scan (CT scan), ultrasound , magnetic resonance imaging (MRI), and colonoscopy are just a few tests that can help identify specific medical conditions.
  • Surgery: An abdominal laparoscopy is a minimally invasive surgical technique used to visualize internal organs and structures.
  • Biopsy: Certain conditions require a biopsy to make a diagnosis. A piece of tissue from the affected organ or tissue is removed from the body and examined by a pathologist .

How to Treat Lower Left Abdominal Pain

If you have new or worsening pain in the lower left abdominal area, it's important to see a healthcare provider for treatment. Treatment options vary widely depending on the underlying cause of the pain. The following interventions may temporarily relieve the symptoms of lower left abdominal pain:

  • Using a heating pad on the area
  • Placing an ice pack on the area
  • Taking a warm bath or shower
  • Laying or sitting in a comfortable position supported by pillows
  • Drinking warm herbal tea
  • Use of over-the-counter (OTC) pain relievers like Tylenol (acetaminophen) or nonsteroidal anti-inflammatories (NSAIDs)
  • Eliminating gas-producing or acidic foods from your diet

Lower left abdominal pain can be caused by several medical conditions that affect the organs in this area, such as parts of the digestive system, urinary system, and the female reproductive system. Underlying causes can sometimes be serious, so early detection is essential to diagnosing and treating the reason for pain in this area.

Johns Hopkins Medicine. Chronic pain .

FitzGerald JF, Hernandez Iii LO. Ischemic colitis .  Clin Colon Rectal Surg . 2015;28(2):93-98. doi:10.1055/s-0035-1549099

Corridoni D, Arseneau KO, Cominelli F. Inflammatory bowel disease .  Immunol Lett . 2014;161(2):231-235. doi:10.1016/j.imlet.2014.04.004

Strate LL, Morris AM. Epidemiology, pathophysiology, and treatment of diverticulitis .  Gastroenterology . 2019;156(5):1282-1298.e1. doi:10.1053/j.gastro.2018.12.033

Yashiro M. Ulcerative colitis-associated colorectal cancer .  World J Gastroenterol . 2014;20(44):16389-16397. doi:10.3748/wjg.v20.i44.16389

National Institute of Diabetes and Digestive and Kidney Diseases. Urologic diseases .

Centers for Disease Control. Common reproductive health concerns for women .

MedlinePlus. Ectopic Pregnancy .

MedlinePlus. Ovarian cysts .

MedlinePlus. Shingles .

HerniaSurge Group. International guidelines for groin hernia management.  Hernia . 2018;22(1):1-165. doi:10.1007/s10029-017-1668-x

By Serenity Mirabito RN, OCN Serenity Mirabito, MSN, RN, OCN, advocates for well-being, even in the midst of illness. She believes in arming her readers with the most current and trustworthy information leading to fully informed decision making.

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  4. Phantom Limb Pain

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  3. The WEIRDEST FEELING Missing a Leg PHANTOM PAIN explained

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COMMENTS

  1. Phantom Limb Pain: What is It, Causes, Treatment & Outcome

    The phantom part refers to the location of the pain: the missing limb or part of the limb (such as fingers or toes). Phantom limb pain ranges from mild to severe and can last for seconds, hours, days or longer. It may occur after a medical amputation (removing part of a limb with surgery).

  2. Phantom Pain Symptoms, Causes, Medications, and Treatments

    The exact cause of phantom pain is unclear, but it's thought to be related to: Nerve damage The removal of a body part causes damage to peripheral nerves. This can irritate and overexcite...

  3. What is phantom pain? Examples, cause, and treatment

    Phantom pain refers to pain in a part of the body that is no longer present, such as an amputated limb or an organ that a surgeon has removed. To a person with phantom pain, it feels as...

  4. Phantom Limb Pain After Amputation: Causes & Treatments

    Causes Researchers don't know exactly what causes phantom limb pain. One possible explanation: Nerves in parts of your spinal cord and brain "rewire" when they lose signals from the missing...

  5. Phantom Pain: What It Is, Its Causes And Treatments

    Phantom pain is a type of chronic pain that occurs when an amputated part of the body is still sending signals to the brain that it is there. As you can imagine, feeling such pain can be incredibly aggravating.

  6. Understanding Phantom Pain: Causes, Symptoms, and Management

    Phantom pain is a sensation of pain that feels like it's coming from a limb or a part of the body that's no longer there. It is a common experience among amputees. The "phantom" pain can vary greatly among individuals, ranging from mild to severe, and may feel like throbbing, stabbing, twisting, or burning.

  7. Phantom pain

    Pathophysiology The neurological basis and mechanisms for phantom limb pain are all derived from experimental theories and observations. Little is known about the true mechanism causing phantom pains, and many theories highly overlap. Historically, phantom pains were thought to originate from neuromas located at the stump tip.

  8. Phantom Pain Treatment After Amputation Surgery

    burning, or similar to cramps. The pain often feels as if it is located in the part that is the greatest distance from your healthy body. For example, after a leg amputation, the foot (which is no longer there) may feel phantom pain. What Causes Phantom Pain?

  9. Phantom Limb Pain: Causes, Symptoms, and Treatment

    What causes phantom limb pain? It can be both frustrating and confusing for patients to experience phantom limb pain. We think of pain as a physical response to external stimuli; so, if the stimuli aren't there, why is the pain? For decades, doctors believed that this condition was solely a psychological phenomenon. However current research ...

  10. Phantom-limb pain: characteristics, causes, and treatment

    Phantom-limb pain is a common sequela of amputation, occurring in up to 80% of people who undergo the procedure. It must be differentiated from non-painful phantom phenomena, residual-limb pain, and non-painful residual-limb phenomena.

  11. Phantom Limb Pain

    Phantom limb pain (PLP) is a common and complex condition that affects many amputees. It is the sensation of pain or discomfort in a limb that has been removed. This book chapter provides an overview of the causes, diagnosis, and treatment of PLP, as well as the differences between PLP and residual limb pain (RLP). It also discusses the current challenges and controversies in the management of ...

  12. What causes phantom limb pain? A new theory

    The brain is known to have a sensory "map" of different body parts, and previous research suggested that phantom pain results when the part of that map that represented the former limb is taken...

  13. Clinical updates on phantom limb pain

    Key Points Phantom pain and other pain entities are highly prevalent (up to 80%) in patients after amputation.

  14. Phantom Limb Pain

    Phantom limb pain (PLP) is defined as "pain that is localised in the region of the removed body part" [2]. It is a poorly understood clinical phenomenon that remains the subject of intense research due to the acute and chronic nature of the condition. The incidence is reported to be as high as 60-80% in patients post-amputation [3] and risk ...

  15. Royal Orthopaedic Hospital

    Phantom limb pain can be unpredictable. You may feel it as soon as the anaesthetic wears off, though it may take time (even weeks) to appear. Sensations may change and often fade in time, or they may continue for years, even a lifetime. Everyone's experience of their phantom limb is unique to them, though there are some common experiences.

  16. Phantom Pain: Causes, Symptoms, and Treatments

    If you are suffering from pain that could be caused by phantom pain, we can help. What Causes Phantom Pain? Phantom pain is often felt soon after limb loss, but it can also come on as much as six months later and even years afterwards. The exact cause of phantom pain is unknown, but some factors are considered risk factors and can worsen pain:

  17. Psychological Factors Associated with Phantom Limb Pain: A Review of

    Phantom limb pain (PLP) is a common phenomenon occurring after the amputation of a limb and can be accompanied by serious suffering. Psychological factors have been shown to play an important role in other types of chronic pain, where they are pivotal in the acquisition and maintenance of pain symptoms. For PLP, however, the interaction between ...

  18. Residual limb pain

    Residual limb pain is different from phantom pain, which is pain that seems to come from an amputated limb. But residual limb pain and phantom pain often occur together. Research shows that more than half of people with phantom pain also have residual limb pain. Residual limb pain may be caused by: Problems in the bone or the soft tissue; Infection

  19. Phantom Pain

    . Call 1860-500-1066 to book an appointment. What are the Causes of Phantom Pain? Though the exact cause is uncertain, it seems to emanate from the spinal cord and brain. During scans like PET or MRI, the parts in the brain that had been connected neurologically to the nerves of amputated limb show some activity when the person feels phantom pain.

  20. Phantom Limb Pain: Causes & Treatments

    The underlying root cause of phantom limb pain is not clear, but it originates in the spinal cord and brain. This is believed to be caused by a mixed signal in the brain. After amputation occurs, spinal cord and brain areas miss input sensations from where the limb should be. The body takes time to adjust. However, this lack of input sensations ...

  21. Phantom pain and the brain

    Phantom pain and the brain. Monitor on Psychology, 38 (1). https://www.apa.org/monitor/jan07/pain Scientists have long conceptualized the part of the brain known as the primary somatosensory cortex (S1) as where it first registers touch sensations.

  22. Breakthrough reveals new treatment to relieve phantom limb pain

    Stimulation of the spinal cord can alleviate "phantom" pain for people who have had a limb amputated, suggests a new study. Researchers found an electrical pulse delivered to the spinal cord of ...

  23. 10 Causes of Pain on the Outer Side of Your Foot

    Causes of pain on the outer side of your foot. If your lateral foot pain does not get better with rest or starts to feel worse, it's important to seek medical attention. Ankle sprains. sprain or ...

  24. Can Constipation Cause Back Pain?

    Irritable bowel syndrome (IBS): This chronic functional bowel disorder involves changes in bowel habits. The IBS-C subtype and IBS with mixed bowel habits subtype can cause both constipation and back pain. Other common IBS symptoms may include stomach cramps, bloating, and diarrhea. Fibromyalgia: In cases of fibromyalgia, individuals may ...

  25. Unveiling the phantom: What neuroimaging has taught us about phantom

    Abstract. Phantom limb pain (PLP) is a complicated condition with diverse clinical challenges. It consists of pain perception of a previously amputated limb. The exact pain mechanism is disputed and includes mechanisms involving cerebral, peripheral, and spinal origins. Such controversy limits researchers' and clinicians' ability to develop ...

  26. Dear Doctor: What is neuropathy of the feet and what tests are needed

    ANSWER: "Neuropathy" is not a diagnosis; it's a name for a diverse group of diseases that cause damage to the nerves and may signify nerves of the brain and spinal cord, or those outside ...

  27. Lower Left Abdominal Pain: Causes and Treatment

    Some small intestine and colon disorders can cause lower left abdominal pain, including: Irritable bowel syndrome (IBS): A functional gastrointestinal disorder that results in abdominal pain, cramping, and diarrhea. Colitis: Infections, immunotherapy treatment for cancer, and food allergies can cause the colon to become inflamed and painful.