Many people seen surprised to find, that someone with a missing limb might have peripheral neuropathy; I don’t know why… they are like anyone else and can suffer from the same maladies, such as neuropathy, diabetes or other issues. In fact, diabetes may even be the reason they are missing the limb in the first place! In the same sense, if one, previously, has peripheral neuropathy, ‘losing a limb’ doesn’t necessarily mean that one ‘loses’ the neuropathy in that leg too! Many times, the patient suffers from, what the layperson probably HAS heard of…, “phantom pain.”
Diabetics are especially susceptible to phantom pain when they lose a limb; as the brain ‘remembers’ the pain it once had, but doesn’t really realize that the limb might be missing. So some people may feel discomfort in the leg even though it is not there. Even simple things like ‘itching’ can be felt in the missing area; surprisingly, often, if someone ‘itches’ in the air near the where the itch would have been, the itching sensation can often be relieved. “ Psychosomatic?” Perhaps!
But, when one has peripheral neuropathy, it is a somewhat different matter. Most neuropathies occur in both feet; so when a foot or leg is missing, the ‘neuropathy,’ often, is still there. Sometimes, we can just put an electrode on the ‘stump’ and that takes care of the problem with some neuromuscular stimulation. But other times, we need to go to extreme measures and ‘fool’ the brain, so to speak.
I keep a full length mirror on my office hallway wall for a reason; it’s not that I want to check my or my patients hair or clothing, I am, merely, storing the mirror on the wall, out of the way. Why, you might ask? When an amputee patient with neuropathy comes in, I take the mirror off the wall and place it between the patients full leg, and what is left of the missing leg. (If the leg is missing from the hip, then I’ll have someone hold the mirror in place.) The patient ‘leans’ a bit toward the full leg and looks in the mirror. Of course, what they see is a ‘reverse’ image of their leg… (in other words, two legs!) the same, as if they were looking down at both legs, if one wasn’t missing.
For whatever reason, the brain sees this reflection and associates it with the missing leg; so, again, if one had a ‘pain’ on the missing leg, the brain could be ‘fooled’ into relieving that pain! Confusing? How, exactly does this work? First, as previously mentioned, the brain is fooled by the reflection; but then, we fool it even more by attempting to remove the other symptoms in the phantom leg the way we do with a normal leg. We can use massage therapy on the opposite foot, acupuncture or even neuromuscular stimulation. In other words, if we were to put an electrode on the full leg, chances are, the patient would ‘feel it’ in the missing leg as well; and the symptoms are relieved. In extreme cases, we will place an electrode on the ‘stump’ of the missing leg as well… in an effort to ‘retrain’ the muscles and nerves to feel actual sensations and to ‘forget’ the phantom pain.
This can be done just as easily with missing hands/arms, as it can with the feet; and, best of all, one doesn’t have to be a physical therapist or neuropathist to do it at home. Yes, therapy is best left to the professionals… but, if one can’t receive the therapy they need, ‘home therapy’ is the next best thing; and, one really doesn’t have to be an expert to achieve some impressive results. Full length mirrors can be purchased cheaply in many stores or thrift stores for $20 or less! And/or one can make a ‘Mirror Box’ at home to use for themselves or with a family member almost as easily. Of course, there are many different models available on the internet for purchase too! Placing the affected limb into the box, simple stimulation/sensation is added in the form of massage, or heat and cold, or pin prick. Anything, to make the brain feel like there is ‘sensation’ when it sees it in the mirror.
The next question I, generally, get asked it: “Well, if this works with missing limbs, what about non-functional limbs… like from stroke or accident?” The same treatment holds true. Mirror Boxes can be purchased or made for foot/leg use as well or simply go back to a wall mirror. Reflection and stimulation of the functional hand or foot, will fool the brain and help to ‘reroute’ the nerves which may have been damaged through stroke or accident. Even exercise, such as squeezing a ball with the functional hand, will cause nerves and muscles in the affected limb to respond.
Does this work for everyone? Certainly not; but it works for many more than expected!
My next Blog, will go into more detail as to “Making a Mirror Box” and the treatment for non-functional limbs.