Overview & Efficacy: Several small studies have shown that biofeedback based treatments which successfully teach people to control abnormal spasms and blood flow in the residual limb (stump) can reduce or eliminate cramping and burning descriptions of phantom pain but not shocking - shooting descriptions of phantom pain.

This therapy is rated as possibly efficacious (level 3 on a scale of 1 - 5 with 5 being the best).

Why biofeedback would help this problem: Phantom limb pain occurs among people who have lost a limb for any reason (accident, war injury, vascular disease, etc.). The pain seems to be coming from the portion of the limb which has been removed. Studies have shown that burning / tingling descriptions of phantom pain are caused by too little blood flowing in the stump (residual limb) while cramping / twisting descriptions are caused by spasms in the major muscles of the stump. Causes of other, fortunately rarer, descriptions of phantom pain are not known.

Numerous studies have shown that people can learn to increase blood flow to their limbs while others have shown that people can control spasms in the muscles of their limbs. Amputees, even those with vascular diseases, can learn to increase blood flow in the stump and control spasms in the stump. Those amputees reporting burning / tingling phantom pain who can learn to increase blood flow in their stumps to normal levels eliminate their pain to the extent the blood flow level remains normal. Those amputees reporting cramping / twisting phantom pain who can learn to control the spasms in their stumps eliminate their pain to the extent the spasms remain controlled.

Muscle tension biofeedback to control cramping phantom pain usually takes between one and ten sessions. Temperature biofeedback to control burning phantom pain usually takes between ten and twenty sessions.

Brief summary of evidence supporting the efficacy of biofeedback for phantom pain:

Several small studies summarized in Sherman (1996) have related the effectiveness of behavioral and medical treatments of phantom pain to underlying physiological correlates. When research on amputees demonstrated that decreased blood flow in the stump was related to increased burning phantom limb pain, peripheral vasodilators and temperature biofeedback were used to decrease the phantom pain. When increased muscle tension and spasms in the stump were related to episodes of cramping phantom pain, muscle relaxants and muscle tension biofeedback were used to control the pain.

Researchers found EMG biofeedback to be effective for thirteen of fourteen trials for cramping phantom pain. EMG biofeedback had minimal success with two and no success with ten of twelve trials for burning phantom pain. It had no success with eight trials of shocking phantom pain. Temperature biofeedback was ineffective for four trials of cramping phantom pain, was effective for six of seven trials with burning phantom pain, and had no success with three trials for shocking phantom pain. Nitroglycerine ointment (a topical vasodilator) was ineffective for one trial of cramping phantom pain and one of shocking phantom pain but successful for two trials of burning phantom pain.

Trental (a blood viscosity enhancer) was ineffective for two trials of cramping phantom pain and one of shocking phantom pain. Nifedipine (a systemic vasodilator) was effective for three trials of burning phantom pain but ineffective for one trial of cramping and two trials of shocking phantom pain. Flexeril (a muscle relaxant) was effective for two trials of cramping phantom pain but ineffective for one with shocking phantom pain. Indocin (an anti-inflammatory agent) was ineffective for two trials of cramping phantom pain. The overall conclusion from this investigation is that varying types of phantom pain respond virtually only to interventions which alter the underlying mechanisms.

Follow-up Durations: Only one study with significant follow-ups has been reported (Cf., review in Sherman, , Devor, Jones, Katz, Marbach, 1996). Use of EMG biofeedback combined with home use of progressive muscle relaxation exercises showed excellent success with six month to three year follow-up for fourteen of sixteen successive phantom pain patients.

Treatment Success vs. Learning to Control the Appropriate Physiological Parameter: The major difference between those patients in the above study who succeeded in learning to control their pain and those who did not was the ability to relax in any measurable way. The two failures neither (a) demonstrated the ability to relax, nor (b) reported subjective feelings which would be associated with learning to relax or to control their muscle tensions.

For an 'in depth' look at the entire area of phantom pain, one might read the book Phantom Pain by Sherman, , Devor, Jones, Katz, Marbach,1996.

Detailed information on biofeedback augmented treatment of chronic pain

A. Citation to the book noted in the "brief summary":

Sherman R: Pain Assessment and Intervention from a Psychophysiological Perspective. Association for Applied Psychophysiology, Wheat Ridge Colorado, 2004. (Book)