Behavioral Methods to help with Cramping and Burning Pain

Phantom pain is especially difficult for amputees to deal with and pain medications don’t always work.  Behavioral methods for dealing with this pain have been in use since the 1970s.  The burning pain experienced by phantom pain sufferers seems to be related to a lack of blood flow to the distal part of the stump and, through various techniques, the degree of circulation to the superficial vessels of the stump can be controlled by the patient.  Muscle cramping also plays a role in the phantom limb pain and this can be controlled as well.  The shooting and shocking pain these sufferers deal with cannot, however, be controlled as they have no physiological reason known behind these types of pain.

A surface EMG test can show if there is muscle tension in the affected limb. When there are changes in the EMG of this limb, it is accompanied by cramping pain.  As to the burning pain, when the stump is cooled, the surface blood vessels contract, resulting in decreased blood flow and an increase in this type of pain.  This makes amputees much more sensitive to the cold; drinking whiskey, which tends to increase peripheral blood flow, doesn’t seem to work in this type of pain.  Amputees can be taught, through biofeedback, to increase the circulation of the affected area, which decreases the pain. 

A sympathetic nerve block to the amputated limb can increase the circulation to all parts of the affected limb, which decreases the sensation of burning pain.  This, besides behavioral treatment, can be effective in reducing the pain.  Beta blockers also increase peripheral circulation and have been used for the short term relief of burning phantom limb pain. 

Muscle tension biofeedback and the use of muscle relaxants together can decrease the incidence of cramping phantom limb pain.  In the same way, biofeedback directed at increasing peripheral blood flow along with peripheral vasodilators work really well in decreasing burning pain.  Nitroglycerine ointment can be used to increase the circulation when applied to the end of the stump.  Nifedipine orally is still another vasodilator. 

Biofeedback is especially good because it can address both kinds of pain at the same time.  Biofeedback involves giving the patient a realistic physiological parameter and allowing them to use the brain to change those parameters.  Eventually, the patient can do this without seeing the monitor showing the physiological parameter and the patient just “knows” how to make the parameter change.  In the case of cramping pain, an EMG is used to detect muscle tension. Information about peripheral blood flow is also given to the patient in order to increase the blood flow and temperature of the limb affected so that the patient can control this and reduce the degree of pain.

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