Phantom Limb Pain

What is phantom limb pain (phantom pain)?

Phantom limb pain is pain that you feel in the part of a limb that was removed after an amputation. It might seem unusual to feel pain in an area of your body that doesn’t exist anymore, but the pain you feel is real.

Phantom limb pain ranges from mild to severe and can last for seconds, hours, days or longer. A healthcare provider can help you manage phantom pain.

What are the types of phantom pain?

There are different types of feelings or sensations you can have after an amputation. Not all sensations involve pain. Healthcare providers describe these sensations with the term “phantom,” relating to the missing limb (arm or leg) or removed part of your limb (like a finger or toe).

After an amputation, you might experience:

• Phantom pain: You feel pain in the missing limb after an amputation.
• Phantom sensations: The missing limb still feels like it’s part of your body. There isn’t any pain, but you feel sensations of touch, pressure, itch, temperature and vibrations. You may forget that part of a lower limb is missing and try to walk on both legs, for example.
• Phantom pain syndrome: You feel pain and other sensations like touch, pressure, itch, temperature and vibrations in an area of your body that experienced an amputation.
• Residual limb pain: This is pain that affects the remaining part of your limb (stump) that’s still on your body after an amputation. Residual limb pain often has a medical reason, such as infection or nerve damage.

How common is phantom limb pain?

Over half of people who lose a limb experience phantom pain.

What does phantom limb pain feel like?

Phantom pain causes painful sensations in an area of your body where you no longer have a limb. It might feel like:

• Aching.
• Burning.
• Itching.
• Numbness.
• Pinching.
• Tingling.
• Stabbing.
• Temperature change.
• Throbbing.
• Twisting.

You might feel like your missing limb is:

• Still attached.
• In an unusual position.
• Moving around.
• Shrinking.

When will I feel phantom limb pain?

Many people report that they feel phantom pain during the first six months after a limb loss. The pain intensity and frequency usually decrease after that. Research shows most people continue to have some phantom pain two years after amputation.

What triggers phantom limb pain?

Phantom pain might trigger (start) or get worse if you have:

• Fatigue.
• Stress.
• Anxiety.
• Depression.
• An infection.
• Blood flow issues.
• Pressure or swelling on the stump.

What causes phantom pain?

Healthcare providers aren’t sure of the exact reason why phantom pain occurs. Many believe it’s a miscommunication in your nervous system. Your peripheral nerves send signals to your spinal cord and brain. These signals tell your body to move. After an amputation, the nerve connection still exists within your body, even though the nerves in the amputated body part aren’t there anymore.

An amputation causes trauma. Your brain is learning how to adjust to the change. Sometimes, nerves can get angry in response to trauma or change. They may send more signals than they usually do or mix up signals. Your brain misinterprets the signals it receives, which increases your sensitivity and leads to pain.

What causes residual limb pain?

You may also feel pain in the remaining part of your body that wasn’t amputated. This is a residual limb or stump. Since this part of your body still exists, several complications can happen that may be causing the pain:

• Bruising.
• Bone infection (osteomyelitis) or bone spurs.
• Inflammation (neuroma).
• Nerve damage (neuropathic pain).
• Poor blood flow.
• Poorly fitting prosthetic device.
• Pressure injuries (bedsores).
• Skin or wound infections.

You can experience residual limb pain at the same time as phantom limb pain.

What causes phantom limb sensation?

Phantom limb sensation (feelings of touch without pain) happens because your brain is trying to rearrange sensory signals after an amputation. Your body naturally sends signals to your limbs throughout your entire life. If there’s an amputation, your brain needs to relearn where to send signals to adapt to the change. It takes time to learn something new. In the same way, your body needs time to adjust, which is why you feel phantom sensations.

What are the risk factors for phantom limb pain?

Anyone who has an amputation can develop phantom pain. It’s more common in upper extremity amputations (arms and fingers) but it can affect any part of your body.

If you regularly wear a prosthetic device, you might find the pain is worse when you aren’t wearing a prosthetic.

What are the complications of phantom limb pain?

Living with pain isn’t easy. Phantom limb pain can have a serious impact on your mental health and, in some cases, lead to anxiety or depression.

The pain you feel can interfere with your ability to sleep or get a good night’s rest. Pain can also distract you from your daytime responsibilities and prevent you from participating in activities you enjoy. A healthcare provider can help you manage pain so you can feel better.

How is phantom limb pain diagnosed?

A healthcare provider will diagnose phantom limb pain after a physical exam and testing. They’ll ask you questions to learn more about what you feel. Then, your provider will examine your skin near the amputation location. They’ll look for open wounds or signs of infection.

Testing can help rule out other possible causes of your pain. They may order blood tests or imaging tests, if necessary.

Since an amputation can significantly impact your mental and emotional well-being, your provider might recommend a psychological evaluation. Stress, anxiety and depression can trigger phantom pain, so an evaluation is a helpful tool to find what’s causing your pain so they know how to treat it.

How is phantom pain treated?

Treatment for phantom limb pain may include:

• Medications.
• Mirror therapy.
• Transcutaneous electrical nerve stimulation (TENS).
• Spinal cord stimulation.
• Neurostimulation.
• Stump revision surgery.

These complementary therapies may also help with phantom pain:

• Acupuncture.
• Biofeedback.
• Cognitive behavioral therapy- (CBT).
• Massage therapy.
• Meditation or mindfulness exercises.

There are a variety of treatment options for phantom pain, so your provider will help you find the right one for your situation. You may need more than one or a combination of treatments to relieve your pain.

Mirror therapy for phantom limb pain

Mirror therapy is a technique that uses a mirror to create an illusion to convince your brain that your amputated limb is still attached.

During this therapy, a mirror sits on the same side as the amputated limb, so you can see your unaffected opposite limb when looking in the mirror. The mirror reflection makes it look like your missing limb is still there. A provider will guide movement exercises with your unaffected limb and you’ll watch the movements in the mirror. This tricks your brain into thinking you have two healthy limbs.

You view the intact limb in a mirror while doing movement exercises for about 20 minutes a day.

Over time, your brain processes this information. Since your brain doesn’t think the limb is missing, signals sent between your nervous system don’t get mixed up, so you’re less likely to feel pain. A physical therapist can help you master this exercise.

What medications treat phantom limb pain?

Medications for phantom limb pain vary based on your needs. These include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Prescription pain relievers.
• Antidepressants.
• Antiseizure medications (gabapentin, pregabalin).
• Beta-blockers (propranolol).
• Calcium channel blockers (nifedipine).
• Botulinum toxin B injections.
• Local anesthetic infusion (lidocaine or bupivacaine).

Each medication comes with possible side effects. Your provider will let you know what side effects to look out for during treatment.

How can I prevent phantom limb pain?

There’s no known way to prevent phantom limb pain after amputation. Some studies suggest that using spinal and general anesthesia together during limb amputation surgery may lower the risk of phantom limb pain.

What can I expect if I have phantom limb pain?

The first time you experience phantom limb pain after an amputation, you may feel confused. You might wonder why you have pain in a part of your body that no longer exists. While this type of pain feels unusual for your body, it’s common after an amputation. This pain can interfere with your daily routine and sleep schedule as you’re recovering after losing a limb.

Healthcare providers can help you manage the pain. There are a variety of treatment options available based on your needs.

In addition, an amputation can impact your mental health and emotional well-being. Your treatment plan may include speaking with a mental health professional to manage stress, anxiety or depression that may be triggering phantom pain.

How long do phantom pains last?

There isn’t a specific timeframe as to how long phantom limb pain will last. It may be temporary or long-term (chronic). Pain can last for a few seconds or minutes to days at a time. Each person’s pain is different. Most people experience phantom limb pain for the first six months after an amputation and it usually reduces as your body adjusts to the change. Treatment is available to minimize the impact that phantom pain has on your life.

When should I see a healthcare provider?

You should call your healthcare provider if you experience:

• Pain that interferes with sleep or daily activities.
• Signs of infection, such as fever or skin discoloration in the residual limb.