FAQs on Phantom Limb Pain

Phantom limb pain (PLP) is ongoing painful sensations that are perceived as coming from a portion of the limb that is not there any longer. The limb is no longer present, but the patient still perceives the pain.

How common is phantom limb pain?

Phantom limb pain occurs soon after surgery. Patients describe burning, itching, twisting, and pressure sensations of the limbs. Many people say they feel pain in the fingers or toes, even when these structures are no longer there. Around 80% of amputees report feeling pain of a phantom nature.

How long does PLP last?

PLP diminishes in both the duration and frequency during the first six months following amputation. The length of time the pain differs from person-to-person. For some people, PLP continues for years or the lifetime. Many people are reluctant to report PLP for fear they will be considered insane.

What causes phantom limb pain?

PLP is worse when the patient experienced a traumatic injury before the amputation. PLP occurs due to mixed signals from the central nervous system (CNS), which includes the brain and spinal cord. PLP is worsened by certain triggers. These include:

  • Touch
  • Clothing
  • Weather changes
  • Smoking

What are the risk factors for PLP?

Phantom limb pain is more common in adults than teens and young children. Other things that put a person at risk for PLP include:

  • Preamputation infection
  • Preamputation pain
  • A blood clot in the amputated limb
  • Traumatic amputation
  • Anesthesia used during surgery
  • Previous spinal cord or nerve damage

What are the symptoms of phantom limb pain?

Symptoms occur in patients who have had a limb removed, or those who are born without a limb. The associated signs and symptoms are:

  • Stabbing, shooting, piercing, or burning pain
  • Sensations of numbness, cramping, or tickling
  • Sensations of warmth, coldness, tingling, and itching

Characteristics of phantom limb pain include:

  • Comes and goes or may be continuous
  • Onset the day of amputation or within a few days after surgery
  • Often affects the portion of the limb farthest from the body (foot region)
  • Feels like the phantom part is forced into uncomfortable position
  • Triggered by pressure on the remaining stump region or by emotional stress

What is the treatment of phantom limb pain?

Treating PRP is a multi-factorial process. Pain management specialist often use a combination of treatment modalities. Options include:

  • Medication – Different categories of medications will decrease the pain. The doctor may use several agents, including muscle relaxants, anticonvulsants, antidepressants, opioids, and beta-blockers.
  • Acupuncture – Small needles are inserted along meridians (body regions) to promote healing and restore body energy.
  • Mirror box therapy – This involves use of a mirrored box, which makes the patient see a reflection of the leg and tricks the brain into thinking the amputated body region is still present.
  • Transcutaneous electrical nerve stimulation (TENS) – Mild electrical current is sent through the skin from a device worn outside the body. This interferes with pain signal transmission.
  • Spinal cord stimulation (SCS) – This device is surgically implanted into the body and delivers electric current to the spinal cord. This relieves pain by blocking pain signals.
  • Intrathecal pump implant – For severe pain, the doctor can surgically implant a pain pump that delivers medication straight to the epidural space (surrounds the spinal cord). A research study found this device to offer an 86% success rate for pain reduction.

What can I do at home to help with the pain?

For some patients, control over the pain is an option. Home care includes:

  • Look for distractions – Find activities that take the focus off the pain, such as music or reading.
  • Stay active – Get exercise while doing activities, such as walking, gardening, cycling, and swimming.
  • Seek support of other people – Find ways to be around others, such as friends, support groups, or hobbies.
  • Relaxation techniques – Go swimming, take a hot bath, do meditation, and practice rhythmic breathing.

Resources

Corrado P, Alperson B, & Wright (2006). Perceived success and failure of intrathecal infusion pump implantation in chronic pain patients. Neuromodulation, 11(2), 98-102.