Phantom Limb Pain

Overview

Phantom limb pain is pain that feels as though it is coming from a part of the body that has been removed, most often an arm or leg lost to amputation. Although the limb is gone, the brain and nervous system can continue to generate pain signals that the person experiences as coming from the missing part. The pain is real, not imagined.

Phantom limb pain is different from phantom limb sensation, which is the non-painful feeling that the limb is still present, and from residual limb (stump) pain, which arises from the remaining tissue. Phantom limb pain is common after amputation. For some people it fades over time, while for others it persists and needs ongoing management.

Symptoms

The pain is felt in the part of the limb that is no longer there, often the most distant portion such as the missing hand or foot. People describe it in many ways:

• Shooting, stabbing, or electric-shock sensations
• Burning or aching
• Cramping or squeezing, as if the missing hand or foot were clenched
• Throbbing or pins-and-needles

The pain may be brief and occasional or frequent and severe. It can be triggered or worsened by touch to the residual limb, stress, weather changes, or wearing a prosthesis. Some people also feel that the phantom limb is in an awkward or fixed position.

Causes

Phantom limb pain is a form of neuropathic pain. It is not caused by a single problem but by changes throughout the nervous system after the limb is lost:

• Peripheral nerves: Cut nerve endings in the residual limb can form tangled clusters called neuromas that send abnormal signals.
• Spinal cord changes: The way the spinal cord processes signals can become amplified and disordered.
• Brain remapping: The brain reorganizes the areas that once represented the missing limb, and this rewiring is linked to the experience of pain.

Pain that was present before amputation, such as from injury or disease, may increase the likelihood of phantom pain afterward.

Risk Factors

• Severe or long-standing pain in the limb before amputation
• Residual limb (stump) pain after surgery
• Amputation of an arm or leg rather than a smaller part
• Poorly fitting prosthesis or pressure on the residual limb
• Emotional stress, anxiety, or depression, which can intensify pain

Diagnosis

There is no single test for phantom limb pain. Diagnosis is based on a person's description of pain felt in the missing limb after amputation, together with a physical examination of the residual limb. A clinician will:

• Ask about when the pain started, how it feels, and what triggers it
• Distinguish phantom pain from residual limb pain and from non-painful phantom sensations
• Examine the residual limb for neuromas, infection, poor healing, or prosthesis-related problems

Imaging or nerve studies are used mainly to rule out other treatable causes in the residual limb.

Treatment

No single treatment works for everyone, and care is often combined and tailored to the individual:

• Medications: Certain antidepressants and anti-seizure drugs used for nerve pain, along with other pain relievers, can reduce symptoms.
• Mirror therapy: Using a mirror to create the visual illusion of the intact limb can help retrain the brain and ease pain for some people.
• Physical and occupational therapy: Desensitization, massage, and prosthesis training.
• Nerve-focused treatments: Nerve blocks, transcutaneous electrical nerve stimulation (TENS), and in selected cases procedures or surgery for troublesome neuromas.
• Mind-body approaches: Relaxation, biofeedback, and counseling, which help because stress and mood affect pain.

Prevention

• Good pain control before and around the time of amputation may lower the risk
• Careful surgical technique and well-managed wound healing
• Early rehabilitation and a properly fitted prosthesis
• Treating residual limb pain promptly
• Addressing stress, anxiety, and depression, which can worsen pain

When to See a Doctor

Talk to your healthcare team if pain in the missing limb is frequent, severe, or interfering with sleep, mood, or daily activity, because effective treatments are available. Seek prompt care if the residual limb becomes red, swollen, warm, or has drainage, or if a wound is not healing, as these can signal infection that needs treatment.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Phantom pain — Symptoms and causes.
2. MedlinePlus, U.S. National Library of Medicine. Phantom limb pain.
3. National Institute of Neurological Disorders and Stroke (NINDS). Pain information.
4. Cleveland Clinic. Phantom limb pain.