Phantom Limb Pain

What is phantom limb pain?

After an amputation, some people experience pain in the part of the limb that’s no longer there. This sensation is phantom limb pain. The pain is real. The phantom part refers to the location of the pain: the missing limb or part of the limb (such as fingers or toes).

Phantom limb pain ranges from mild to severe and can last for seconds, hours, days or longer. It may occur after a medical amputation (removing part of a limb with surgery). It can also happen after accidental amputation, when you lose a finger, toe or other body part. Phantom pain can be managed.

How common is phantom limb pain?

An estimated 8 out of 10 people who lose a limb experience some degree of phantom pain.

What’s the difference between phantom limb pain, phantom sensation and residual limb pain?

With phantom pain, a person feels pain where the missing body part should be. Other problems associated with losing part of your body include:

• Phantom sensations: The missing limb or extremity still feels like it’s part of the body. There isn’t any pain. A person experiencing phantom sensations may forget that part of a lower limb is missing and try to walk on both legs.
• Residual limb pain: This pain affects the remaining part of the limb (stump) where the amputation occurred. Residual limb pain often has a medical reason, such as nerve damage or entrapment (pressure on the nerve). It affects approximately 7 in 10 people with limb loss.

Should I bring up the issues I'm having with phantom pain with my healthcare provider?

Yes, absolutely! There is nothing to be embarrassed about or hide from your provider. Even though your limb or other body part is missing, your pain is real. This is a known medical condition. Your concerns will not be dismissed.

Your healthcare provider is there to help you. They are trained professionals, ready to work with you to relieve your pain.

What causes phantom pain?

Phantom pain typically occurs soon after limb loss. It can take three to six months for a wound to heal after amputation. Rarely, the pain comes on months or years later.

Experts believe phantom pain results from a mix-up in nervous system signals, specifically between the spinal cord and brain. When a body part is amputated, the nerve connections from the periphery to the brain remain in place. The brain can misinterpret the information it's receiving or process the signals as the sensation of pain, even if the amputated portion has since been removed.

What causes residual limb pain?

Problems that affect the remaining part of the limb (the stump) cause residual limb pain. These include:

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

What are the risk factors for phantom limb pain?

Anyone who has an amputation can develop phantom pain. Some people find the pain is worse when they aren’t wearing a prosthetic device.

These factors may trigger phantom limb pain:

• Angina (chest pain due to low oxygen to the heart).
• Changes in temperature or barometric pressure.
• Constipation.
• Shingles (herpes zoster).
• Sex or physical touch.
• Smoking.
• Stress.

What are the symptoms of phantom limb pain?

Phantom pain symptoms may be fleeting or last for days. During the first six months after a limb loss, pain intensity and frequency usually decrease. Still, as many as 8 in 10 people continue to have phantom pain two years after amputation.

The phantom pain may feel like:

• Burning or aching.
• Clamping, pinching or vise-like.
• Itching or tingling.
• Shooting or stabbing.
• Throbbing.
• Twisting.

How is phantom limb pain diagnosed?

Your healthcare provider will conduct a physical exam and order tests to rule out causes of residual limb pain, like infections. These tests may include blood tests and imaging scans like ultrasounds.

If your provider can’t identify a cause, your provider may diagnose phantom pain based on your symptoms.

How is phantom limb pain treated?

Treatment for phantom limb pain focuses on easing symptoms. They include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) or prescription pain relievers.
• Antidepressants.
• Antiseizure medications.
• Beta blockers.
• Muscle relaxers.
• Injections

Treatments that send electrical impulses to the nerves, brain or spinal cord may help ease the pain. These include:

• Neurostimulation.
• Spinal cord stimulation.
• Transcutaneous electrical nerve stimulation (TENS).

What is mirror therapy for phantom limb pain?

Studies suggest that mirror therapy can help ease phantom pain. During this therapy, you view the intact limb in a mirror while doing movement exercises for about 20 minutes a day. The reflection tricks the brain into thinking there are two healthy limbs.

Over time, the brain encodes this information. You may need to repeat the exercises for your pain to diminish. Since the brain doesn’t think the limb is missing, it doesn’t feel pain in the phantom limb. A physical therapist can help you master this exercise.

What other therapies help phantom limb pain?

These complementary therapies may also relieve phantom pain:

• Acupuncture.
• Biofeedback.
• Massage.
• Meditation or mindfulness exercises.

What are the complications of phantom limb pain?

Chronic phantom pain can harm your quality of life. It can also affect sleep. You may develop anxiety or depression. Medications and talking to a therapist can help.

Can you prevent phantom limb pain?

Some studies suggest that using spinal and general anesthesia together during limb amputation surgery may lower the risk of phantom limb pain.

What is the prognosis (outlook) for people who have phantom limb pain?

Phantom limb pain often improves over time. Eventually, it may go away completely. Chronic pain can affect your ability to enjoy life, but a combination of medications and other therapies can ease the pain.

When should I call the doctor?

You should call your healthcare provider if you experience:

• Severe pain that interferes with sleep or daily activities.
• Signs of infection, such as fever or redness in the residual limb.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

• What treatments can ease my pain?
• How long will this pain last?
• Should I try physical therapy or mirror therapy?
• Should I look out for signs of complications?

A note from Cleveland Clinic

Phantom limb pain is a common occurrence after amputation or extremity loss. You shouldn’t feel embarrassed to seek help. These feelings of pain are real. It’s also possible to have an infection or other problem in the remaining part of the limb (the stump) that causes pain. Your healthcare provider can determine the cause of pain and provide treatments. Phantom limb pain often improves over time.