How Compounding Pharmacists Can Help Veterans Manage Phantom Limb Pain
By now it’s no secret that medical technology has reached a point where our soldiers come home from combat alive, but with injuries that need long-term treatment. Consider the case of Christian Bagge, a National Guard soldier whose unit was hit by two Iraqi bombs back in 2005, when he was just 23 years old. Bagge survived the attack, but both of his legs had to be amputated, one above the knee and the other just below the knee. In Bagge’s words, “the pain and everything just consumes you.”1 He meant the pain of losing his legs and the other injuries he sustained, but he was also talking about phantom limb pain—that is, the pain in legs he no longer had.
Phantom limb pain (PLP) is not a new phenomenon but it is an increasing problem and one that’s hard to solve. Pain management for these patients involves treating both acute pain from the initial injury and chronic pain from signals the brain is expecting from the missing limb. Treatment is unique to each patient, their medical profile, and what their body now responds to; further, as the patient heals and the body starts processing the injury, a treatment that once worked well may no longer be effective. By developing a custom medication regimen that benefits each individual differently and can be adjusted over time, compounding pharmacists can offer these veterans a tangible way to reduce their pain and return to their regular daily lives.
What Does Compounding for Veterans with Phantom Limb Pain Entail?
According to a report in the British Journal of Anaesthesia, there are three different types of sensation that make up what is known as the phantom complex: phantom limb pain, phantom limb sensation (non-painful), and stump pain.2 The onset of stump pain occurs rapidly, perhaps in the first few days after amputation. Phantom limb pain, on the other hand, can be rapid or can set in after months or even years following surgery. The pain is most often intermittent and localized in distal parts of the missing limb. While stump pain may not be easily treated, there is usually a place to start, such as infection, bone spurs, tumors, or scar tissue. Where does compounding for veterans with PLP even begin?
As explained by the American Pain Foundation, the brain has a hard time understanding what the loss of a limb means. In response, it tries to recreate the limb using nerve signals as a guide—unfortunately the brain often translates these nerve signals into pain. “It’s as if the brain needs strong, impossible-to-ignore reassurance that the limb still exists.”3
While there is no single treatment for any individual patient suffering from PLP, much less for the class of patients in general, the first place to start seems to be with medications that calm the nerves. Options to consider include anticonvulsant medications, tricyclic antidepressants such as amitriptyline, and painkillers like opioids and lidocaine. Sodium channel blockers, calcitonin, and NMDA receptor antagonists have also shown variable efficacy in patients. Some patients have anecdotally found relief with topical capsaicin while others have not—the thing to remember here is that PLP is unique to each patient and requires a lot of patience, from both patient and pharmacist.
Psychological therapy is definitely indicated long term, but initial pain through medical management can give the patient the push he or she needs to start on the healing path. A recent study also showed that patients undergoing mirror treatment—that is, forcing the brain to accept the loss of a limb by showing it movement of the intact limb pair—can also result in some pain reduction.4
Is There Anything Else Pharmacists Can Do for Our Veterans?
There are key questions pharmacists should ask when compounding for veterans with PLP, such as5:
- How intense is the patient’s pain?
- Where is the pain located and is that pain localized or general?
- How is the patient functioning in daily activities?
- Does the patient suffer from mood changes?
- How well does the patient sleep?
- How is the patient’s quality of life?
- Is the patient satisfied with pain control relative to any side effects or adverse events?
PLP can change as the patient heals or ages. It’s important for pharmacists to stay on top of these changes and adjust or change medications as needed. Pharmacists can also help patients keep track of what their insurances covers; in the wake of changing coverage for military benefits, it’s increasingly up to the pharmacist to make sure her patients get the pain relief they need and submit authorization forms when the medication needed isn’t covered.
Soldiers like Bagge and thousands of others have given all they can to their country; in return we can give them the pain relief and custom treatment we can provide.
Pharmaceutica North America is proud to provide safe and high-quality compounding materials for all of your patients, including military service members. We understand compounding for veterans can be a long and often frustrating process can that pain affects every aspect of a patient’s life. We are passionate about understanding new research in pain and pain relief so you can help your patients live life to the fullest. Contact us today to learn more.
- “Oregon’s Christian Bagge made an impression on the former president,” May 26, 2009, http://blog.oregonlive.com/oregonatwar/2009/05/oregons_christian_bagge_made_a.html ↩
- “Phantom Limb Pain,” 2001, http://bja.oxfordjournals.org/content/87/1/107.full ↩
- “Phantom Limb Pain, January 20, 2016, http://consumer.healthday.com/encyclopedia/pain-management-30/pain-health-news-520/phantom-limb-pain-646208.html ↩
- “Mirror therapy for phantom limb pain: Brain changes and the role of body representation,” December 10, 2013, http://onlinelibrary.wiley.com/doi/10.1002/j.1532-2149.2013.00433.x/full ↩
- “Pharmacologic interventions for treating phantom limb pain,” December 7, 2011, http://bit.ly/1Tfr3EX ↩