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Phantom Pains

Although amputations are visible the phantom pains are not.  The exact cause of phantom pain is still unknown  but originates in the spinal cord and brain.  when a patient feels these pains, it can be seen in a MRI machine.    It is believed that it is a response from mixed signals from the brain.

When a amputation takes place, areas of the spinal cord and brain lose your input from the missing limb and adjust to this detachment in a unpredictable way.  It may send a message to your brain the pain is else where.   Because the sensory information is referred elsewhere-from a missing hand to a present cheek.  So when the cheek is touched its as the missing limb is present.  It is a version of tangled sensory wires.  Thus results in pain.

Phantom pain can be caused by damaged nerve endings, scar tissue at the site of amputation and the physical memory of pre-amputation pain.

Know your triggers, usually you can feel a tingle or some sensation before pain begins, Try to empty your bladder, don’t get constipated, drinking alcohol can add to the pain,  If you learn your triggers you may be able to stop them before they happen,  meditation, calming one self down can prevent the pain.  Number one trigger is Stress!  so if you can exercise, de stress, calm down, you may be able to find tricks by massaging the limb before bed to help prevent the pain or using a (tens) machine to the affected limb.

Treatments and drug

Acupuncture and Transcutaneous electrical nerve stimulation

(TENS), have been found to be effective treatment for those that don’t want to take oral medications.  Also more invasive options include injections or implanted devices .  This is usually a last resort.

Medications

Although no medications specifically for phantom pain exist, some drugs designed to treat other conditions have been helpful in relieving nerve pain.  Not every pain medication will work for every person’s pain.

Medications used in the treatment of phantom pain include:

  • Antidepressants. Tricyclic antidepressants may relieve the pain caused by damaged nerves. Examples include amitriptyline, nortriptyline (Pamelor) and tramadol (Conzip, Ultram).

    These drugs work by modifying chemical messengers that relay pain signals. Antidepressants may also help you sleep, which can make you feel better.

    Possible side effects include sleepiness, dry mouth, blurred vision, weight gain, and a decrease in sexual performance or desire.

  • Anticonvulsants. Epilepsy drugs — such as gabapentin (Gralise, Neurontin), pregabalin (Lyrica) and carbamazepine (Carbatrol, Epitol, Tegretol) — are often used to treat nerve pain. They work by quieting damaged nerves to slow or prevent uncontrolled pain signals.

    Side effects may include depression, anxiety, suicidal thoughts, irritability, and allergic reactions such as hives, fever and swelling.

  • Narcotics. Opioid medications, such as codeine and morphine, may be an option for some people. Taken in appropriate doses under your doctor’s direction, they may help control phantom pain
  • receotor antagonists. This class of anesthetics works by binding to the NMDA receptors on the brain’s nerve cells and blocking the activity of glutamate, a protein that plays a large role in relaying nerve signals.

    In studies, NMDA receptor antagonists ketamine and dextromethorphan were effective in relieving phantom pain. Side effects of ketamine include mild sedation, hallucinations or loss of consciousness. No side effects were reported from the use of dextromethorphan.

Noninvasive therapies

    • Nerve stimulation. In a procedure called transcutaneous electrical nerve stimulation (TENS), a device sends a weak electrical current via adhesive patches on the skin near the area of pain. This may interrupt or mask pain signals, preventing them from reaching your brain.

      Used properly, TENS is safe. To avoid an unintentional shock, don’t wear a TENS device in the shower or tub or turn it up too high.

    • Mirror box. This device contains mirrors that make it look like an amputated limb exists. The mirror box has two openings — one for the intact limb and one for the stump.

      The person then performs symmetrical exercises, while watching the intact limb move and imagining that he or she is actually observing the missing limb moving. Studies have found that this exercise may help relieve phantom pain.

    • Acupuncture. The National Institutes of Health has found that acupuncture can be an effective treatment for some types of chronic pain. In acupuncture, the practitioner inserts extremely fine, sterilized stainless steel needles into the skin at specific points on the body.

It’s thought that acupuncture stimulates your central nervous system to release the body’s natural pain-relieving endorphins. Acupuncture is generally considered safe when performed correctly.

Minimally invasive therapies

  • Injection. Sometimes injecting pain-killing medications — local anesthetics, steroids or both — into the stump can provide relief of phantom limb pain.
  • Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord can sometimes relieve pain.
  • Nerve blocks. This method uses medications that interrupt pain messages between the brain and the site of the phantom pain.

Surgery

Surgery may be an option if other treatments haven’t helped. Surgical options include:

  • Brain stimulation. Deep brain stimulation and motor cortex stimulation are similar to spinal cord stimulation except that the current is delivered within the brain. A surgeon uses a magnetic resonance imaging (MRI) scan to position the electrodes correctly.

    Although the data are still limited, brain stimulation appears to be a promising option in selected individuals.

  • Stump revision or neurectomy. If phantom pain is triggered by nerve irritation in the stump, surgical resection or revision can sometimes be helpful. But cutting nerves also carries the risk of making the pain worse.

On the horizon

Newer approaches to relieve phantom pain include virtual reality goggles. The computer program for the goggles mirrors the person’s intact limb, so it looks like there’s been no amputation.

Along with this pain from amputation, a patient may experience grief of the loss of the limb amputated, also depression over the loss can be common,  Loss of activity, or ability to work, or function pre amputation.  So support from family and friends are a important part of the recovery of a amputee.

One patient told me the pain was so bad he wanted to cut his entire leg off or kill himself.   Life was not worth living.

 

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How long do antidepressants take to work?

When I was on antidepressants, I wished I knew why they took so long. Now we might.

When I was on antidepressants, I wished I knew why they took so long. Now we might.
August 2, 2016
By James Gaines

Fact Checked
For me, the scariest part of taking antidepressants was the purgatory of waiting to see if they worked.

In 2012, I started taking a medicine called bupropion. For about a month, I watched every single thought that came into my head. And it was, if I may be blunt, pretty damn weird.

Am I having a good day because it’s one of Seattle’s rare sunny winter days? Or is it the drug? If I have a rough day, is it because I’ve hit a natural, temporary low? Or does this mean I’ll have to switch to another medicine (and have to play this game even longer)?

Depression affects about 1 in 5 Americans at some point in their lives, so I know I wasn’t alone. But trying to live outside of your own mind — well, it made me feel kind of messed up and very lonely. I felt like I was a stranger, even in my own head.

It was about a month before I could say for sure that the antidepressants were working.
Antidepressants can take a while to work for lots of people, and we’re still not entirely sure why.

There are many different types of antidepressants, but the most commonly prescribed kinds, known as SSRIs or SNRIs, can take six to eight weeks to reach their full effect. (Frustratingly, the bad side effects can often happen before the beneficial ones.)

Unfortunately, we don’t yet have a complete picture of why that long wait occurs. While we know that antidepressants can work, we’re still learning how depression affects the brain and how different antidepressants can change that.

We know, for instance, that some kinds of antidepressants can help boost mood-altering chemicals known as neurotransmitters, but scientists will admit that’s not the whole picture.
But new research is helping us find and study new pieces of the puzzle.

Take, for instance, the humble G-protein. It turns out that in depressed people, certain proteins called G-proteins get clumped up in our brain cells. G-proteins are part of big signal-transmitting machines in our cells, and if they clump up, the other parts of the machine can’t really get to them. So the signal falters.
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A new study suggests that part of what certain antidepressants do is go into the cell and break up these clumps, helping to repair the machinery. It can take a while for the antidepressants to do their job, though, if the G-proteins are really clumped up. This might explain why that purgatory period exists.

The study notes that different antidepressants may have different or even multiple modes of action, so this “anti-clumping” probably isn’t the only explanation. But this study does help us learn more about how depression works and might even lead to better therapies or medications one day.
If you’re stuck in antidepressant purgatory, there’s science behind it, and it’s OK to feel frustrated.

It might take a while to find out the best course of treatment for you — maybe antidepressants are the answer, but maybe not. There are other courses of action, such as cognitive behavioral therapy, that work well too. The important thing is to find what works for you.

But if you are trying antidepressants and are stuck in that weird, alienating state, know that it’s natural and there’s a reason why — and you’re not alone.

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