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Neuropathic Pain Library

 
 
 

Understanding phantom limb pain

Written by: Joanne Zeis
Published: Thursday, January 21, 2010
Reviewed by: Kevin L. Zacharoff, MD, March 2015

Understanding phantom limb pain

You need to know:

  • Phantom limb pain can happen after the amputation of a body part, such as a foot, arm, or leg.
  • A person with phantom limb pain feels that his or her whole limb still exists (and still hurts) even though it’s no longer there.
  • Up to 80% of people who’ve had a limb amputated have phantom pain.




Jeff never expected his foot to become infected as a result of his uncontrolled diabetes: All it took was that one sore on his foot to change his life. Two months after the sore developed on his ankle – when antibiotics hadn’t stopped the spreading infection – his leg was amputated just below his knee. And two months after that, Jeff wondered if he’d ever be able to stop thinking about his surgery. There were times when his “non-existent foot and toes” hurt and itched just like they were still there. It “drove him nuts.” Was he ever going to get some relief?


What’s happening?

Jeff was really trying to deal with two different problems: phantom limb pain and phantom limb sensation.

Phantom limb pain is pain that seems to come from a painful part of the body that no longer exists, often after an amputation. In Jeff’s case, the pain was caused by the amputation of one of his legs below the knee. Someone else, though, may have the same type of pain after losing an arm, a hand, or even a foot. Up to 80% of people who’ve had a limb amputated may have some degree of phantom pain.

Some of the features of phantom limb pain are:

  • Pain that starts soon after the body part is removed; this is very similar to the original pain
  • Pain that may come and go, instead of being non-stop
  • Pain that covers a wide range of feelings, such as burning pain, shooting or stabbing pains, throbbing, squeezing pain, or deep aches
  • Feelings that seem to come from the farthest part of the amputated limb: For example, phantom pain may come from non-existent fingers, when the arm itself has been removed.

Jeff’s phantom limb sensation, on the other hand, is the itchy feeling that he gets from his amputated leg. Instead of feeling painful, phantom sensations may seem warm, cold, itchy, or tingly. These feelings can be just as frustrating and annoying, though, as the ones caused by phantom pain.


Pain from the brain

It is one thing to understand what phantom pain feels like – but why does it happen at all?

Experts think that it has to do with the brain and the way the nervous system is wired. Every part of a person’s body is linked by nerves to a specific part of that person’s brain or spinal cord. If a person’s right foot is amputated, for instance, his brain starts picking up confusing messages from the cut nerve endings that used to lead to his foot. These “scrambled” sensations can result in phantom pain, and other unexpected sensations.

Some health care providers have tried to keep this pain from happening by giving their patients morphine and other pain relievers for several days before, during, and after surgery; unfortunately, this doesn’t always work.


Are there any treatments to help phantom limb pain?

Your health care provider may prescribe one or more medications to treat phantom pain and phantom sensation. Some of the options include tricyclic antidepressants like amitriptyline, anti-seizure drugs like gabapentin, ketamine (an anesthetic) and calcitonin (a bone-related hormone). These medicines may not help everyone, though.

Other treatment choices could include a TENS unit (a small, portable device that uses a weak and painless current to “interrupt” pain signals before they reach the brain) and acupuncture.

But some promising treatments may be just around the corner. Here are some examples:

  • A mirror box, which uses carefully-placed mirrors to reflect the image of the person’s remaining, whole limb, so that its reflection appears in place of the amputated stump. The person exercises the limb and the stump for a short period of time each day, while looking at the whole limb’s reflection. This method has helped to cut down on phantom limb pain in some sufferers.
  • A virtual reality video game, where movements from a person’s stump are translated into an avatar’s onscreen movements; an avatar is a cartoon version of a real person. This treatment has also had some good results in reducing phantom limb pain.

If you’re dealing with phantom limb pain, or other phantom sensations, talk with your health care provider. You may be able to work together to find some relief.


References

National Institute of Neurological Disorders and Stroke (NINDS)
http://www.ninds.nih.gov (Search on “phantom pain”)

 

Amputee Coalition of America
http://www.amputee-coalition.org (Search on “phantom pain”)

 

National Pain Foundation
http://nationalpainfoundation.org (Search on “phantom pain”)

 

Beth Israel University Hospital: StopPain.org
http://www.stoppain.org (Search on “phantom and stump pain”)

 

MayoClinic.com
http://www.mayoclinic.com (Search on “phantom pain”)