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Spotlight on Phantom Pain

Why Phantom Limb Pain Occurs, and How to Treat It

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Updated November 26, 2009

As many as 80% of amputees experience some kind of “phantom” sensation in their amputated limbs. However, up to half of those who have them do not receive any treatment for or relief from their pain. This makes phantom pain a chronic pain condition.

What is Phantom Limb Pain?

After a limb is removed, you may continue to feel it, as though it were still there. Phantom limb pain is not the same thing as stump pain, which is felt in and around the incision following surgery. Stump pain is localized to the amputation site, while phantom pain is felt in some part of the leg that is no longer attached.

Many people describe burning sensations in their toes though they may be missing their entire leg below the knee. This can be a confusing and even scary sensation, leading some people to believe that they are losing their minds. How can you feel pain in a limb that no longer exists?

Theories About Phantom Pain

No one knows for sure why amputees have phantom pain, but a few possible explanations are widely believed to be true.

  • Memory of limb pain – some researchers theorize that after a limb is damaged beyond repair, the brain is “used to” feeling the pain. Even after the limb has been removed, the brain continues to sense the same kind of pain. It is like having a memory of the pain because the pain is wired into the brain.
  • Nerve bundle stimulation – the severed nerves around the amputation site either misfire or are stimulated in some way, sending a pain message to the brain. These are the same nerves that used to reach all the way into the limb. Sometimes following surgery, these nerves form bundles called neuromas. When they fire, the brain interprets these signals as if the nerve were still intact, and “feels” pain in the toes.
  • Rewiring of the nervous system – there has been evidence that when a limb is amputated, changes take place in the brain and spinal cord that cause pain to be interpreted differently than before. It is not yet clear, however, if this is a cause of phantom pain or if this happens as a result of it.

Symptoms of Phantom Limb Pain

Regardless of its cause, phantom pain can be a debilitating condition. Pain is often described as burning, stabbing and throbbing -- typical descriptor words for neuropathic pain. Phantom pain may happen in a continuous cycle, or it may be brought on by outside factors such as temperature change, stress or stump irritation.

Most people describe their phantom pain as if it were coming from the distal parts of the amputated limb. In other words, feet, toes or hands. Phantom sensations are more common in the first few months after surgery than they are several months down the road, but they can happen at any time after an amputation. So how do you treat pain that isn’t there?

Treatment for Phantom Pain

Like most chronic pain conditions, no single treatment approach works for everybody. A number of medications complementary and alternative treatments out there work for phantom pain. Here are some of the most common approaches.

  • Medication – because it is considered a neuropathic disorder, antidepressants and anticonvulsants are often prescribed for phantom pain. NSAIDSs, opioids and muscle relaxants are also on the list of medications. As with other chronic pain conditions, finding the right medication can take time and patience. Sometimes successful phantom pain relief takes a combination of these medications.
  • Mirror therapy – many therapists use mirrors in their treatments to show the brain into a healthy limb in place of a stump. This usually involves placing both limbs in a mirror box, which makes the amputated limb appear intact. The individual is then asked to perform exercises with “both” limbs. This tricks the brain, and effectively reduces phantom pain for some people.
  • Stump stimulation – using TENS, applying pain-relief patches or rubbing the stump can relieve phantom pain in some people. Using hot packs and cold packs can work for some people. Providing an alternate sensation from the stump can interrupt pain signals.
  • Cognitive therapies – some people find relief from their phantom pain through hypnosis, relaxation or guided imagery. These approaches can change the way the brain interprets phantom sensations, including phantom pain.

Usually more than one treatment approach is used to get phantom pain under control. Some people, however, may require more invasive forms of treatment. These include additional surgery to untangle nerve bundles at the amputation site, stimulation of the spinal cord or the brain to change the way pain is interpreted and implantation of pain pumps that deliver medications directly to the spinal cord.

Sources:

Chan, et al. “Mirror Therapy for Phantom Limb Pain.” Volume 357:2206-2207. November 22, 2007.

King, Stephen A. Clinical Pearls on Phantom Limb Pain. Applied Neurology. October 1, 2006.

King, Steven A. Exploring Phantom Limb Pain. Psychiatric Times. Volume 23, Number 4. April 1, 2006.

National Limb Loss Information Center. Pain Management and the Amputee: Fact Sheet. Accessed March 20, 2009.

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