Pain Manager: Caregivers & Phantom Pain Rehabilitation

Written by: joe.lafollette.susa
Date: Sun, 29 Aug 2010

When pain is chronic, pain pathways created by some abnormal source is usually what someone is coping with. Understanding phantom pain’s pathways is a way to help your client or loved one feel better. When the author was a park ranger, her cabin mate had to have a foot amputated.
Phantom pain can also be treated when appropriate with Tramadol medication. While conversing with clients or loved ones, if you show knowledge about phantom pain they may talk more freely. If a pain medication regime is in place, you can help log information to benefit treatment decision-making.  
 Here is an explanation of what occurs: When a person’s nerve is cut, as in the case with amputation, a tangle of certain nerve components called axons), form a neuroma. Neuromas can create the sensation of pain. If an injury to a nerve completely stops the flow of information to the nervous system, common sense says you should feel nothing in the area where the damaged nerve pathfinders have peripheral terminals.


This line of thought is the case, up to a point. If you stimulate skin in the damaged area, you may have no sensation of Edit this text However, people who have lost their arms or legs report that phantom sensations occur where the limb used to be. For example, after amputation of a limb, most people feel or imagine that the limb is still present, sometimes in a distorted form. Then after some time, the phantom sensation actually can become painful.
Opposite the body's intent, one's healing process itself may create pain. When certain peripheral nerve pathfinders are damaged, the portion closest to the spinal cord is still attached to its cell body, and it survives, but the part close to the skin that's apart from the cell body deteriorates (degenerates). Like a sunflower bending toward the light, these pathfinders attempt to grow toward their old target from the injury, and they can usually reach it, make new receptors, and restore nearly normal sensations.
This series of events, known as regeneration, plays out well when a nerve is smashed rather than cut across. This is because the nerve's coverings are preserved, providing channels for growth.
Most often, pathfinders of sensory nerves don't deliver impulses unless their receptors are stimulated. Axons in nerves are protected from one another:  no synapses related to one another between axons or cell bodies in the backside root ganglion. A situation develops where they don't usually talk. On the contrary, in this system a neuroma goes crazy, and two things take place: The ends of these pathfinders in the neuroma start acting a free-for-all, referred to as spontaneous activity. The pathfinders begin chatting with each other (even though, normally, they ignore one another).
Sensations generated by spontaneously active nerves are felt at (referred to) the sites where the terminals and receptors used to be (such as an amputated leg). This situation is because the brain is fooled into thought that the damaged axons are responding to the same stimuli that normally activated them before the nerve was injured. The activity within a neuroma can even be interpreted by the brain as feeling like the pain of the original injury that set off this unfortunate series of events in the body.
Neuromas can manifest at the site of a nerve injury even if the nerve is not separated and the limb is not amputated. If this occurs, pain is experienced in the territory of the nerve where it's peripheral are located. In either outcome, pain tramadol   medication may be appropriate to palliate the symptoms as part of a rehabilitation platform.

Janet Wilson

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