FAQs on Phantom Limb Pain

Phantom limb pain is the pain experienced after amputation. For many patients, the phantom limb sensations disappear or decrease with time. For others, however, the phantom pain persists for six months or longer, making it a chronic problem.

What causes phantom limb pain?

Although the limb is not there, the nerve endings at the site of amputation continue to transmit pain signals to the central nervous system (brain and spinal cord), which perceives that the limb is still there. The brain memory of pain is retained, persisting long after the limb is gone.

What are the symptoms of phantom limb pain?

Some patients experience a pain sensation, as if the limb is still there. Along with this feeling, other sensations occur, such as tingling, heat, cold, or cramping. The patient can experience any sensation that the actual limb could have felt prior to the amputation procedure.

How common is phantom limb pain?

In a study describing the prevalence and characteristics of phantom limb pain after upper extremity amputations, 144 patients completed a self-report questionnaire. The prevalence of phantom limb pain was approximately 43%, with more than one-third of participants reporting some pain on most days. For most study participants, the pain was described as “discomforting,” and it was associated with some lifestyle interference.

What are the risk factors for phantom limb pain?

The exact reason some people develop phantom limb pain while others do not is unclear. However, several factors increase the risk for this phenomenon. These include:

  • Pain before the amputation – Patients who experience pain before limb removal are more likely to have phantom limb pain following amputation. Experts attribute this to the brain’s memory of the pain.
  • Stump pain – When the amputee has considerable stump pain, he/she is more likely to have long-standing phantom limb pain. Stump pain is associated with abnormal tissue growth on the damaged nerve endings.
  • Poor-fitting prosthesis – If the artificial limb (prosthesis) does not fit correctly, it can cause residual pain.

What treatment options exist for someone with prolonged phantom limb pain?

There are several interventional treatment options for phantom limb pain. While they may not work for every patient, measures include:

  • Medications – While no single medication will work for every patient, several drugs appear to reduce or eliminate phantom limb pain. These drugs include tricyclic antidepressants (work by modifying chemical messengers that detect pain), anticonvulsants (quieten damaged nerves to prevent or slow pain signals), and opioids (used in select nonresponsive patients).
  • Stump injections – The doctor injects a corticosteroid and long-acting anesthetic into the stump. In a 2009 clinical study, numerous patients reported decrease phantom pain sensations after receiving injections of bupivacaine into the stump region.
  • Transcutaneous electrical nerve stimulation (TENS) – Electrodes are attached to the skin near the spine, and they connect to a device worn on the body. Weak electrical current is transmitted via adhesive patches on the skin to interrupt the pain signals, preventing them from reaching the brain. In several clinical studies, TENS was found to be effective for reducing pain in amputees.
  • Acupuncture – With this traditional Chinese therapy, the doctor inserts extremely small, sterilized needles into the skin. The dry needling stimulates the central nervous system to release endorphins, which increase a sense of well-being. One recent case report showed that patients had complete pain relief after acupuncture.
  • Botox – In a 2004 study, researchers found success with the injection of Botox into trigger points on the stump muscles. The study participants reported significant pain reduction following the injections, which involve the instillation of a paralyzing agent into the stump tissue.
  • Physical therapy – Used mostly for amputation related to trauma, physical therapy relieves pain when used along with prosthetic training.