Phantom limb pain is pain that is thought to be coming from a body part that no longer exists, such as an amputated foot. People often report phantom limb in amputated legs or arms, but it can also come from breasts, eyes, or other body parts that no longer exist.

These phantom pains come on shortly after the body part has been removed, usually within days.  The sensations are very unpleasant and can include feelings of:

• Stabbing
• Burning
• Throbbing

What Causes Phantom Limb Pain?

The cause of phantom limb pain is unclear.  The distal pain receptors that were located in the absent body part are gone.  The nerves that carry the signals to the brain however, are usually still present and so are all the connections in the brain.  The wiring in the spinal cord and the brain are extremely important, since normally there are many signals impacting these nerves that allow the body to properly interpret the meaning of the signals.

When a limb is amputated, only a small portion of the wiring is destroyed. The last part of the connections to the limb and the rest of the wiring remain intact.  The brain is still able to receive signals. As a result, the sensory receptive circuits send short-circuited messages of incorrect data.  A sensory signal somewhere in the body starts activating the wires that once lead from the amputated body part. Once they reach the spinal cord, the sensory nerves have many interconnections. These interconnections are intact despite the amputation and can continue to transmit signals.  The brain can now receive these interconnection type signals, and the brain may perceive these signals incorrectly as “phantom” pain.

Phantom pain does not occur with every amputation.  There are several factors that can increase the risk of phantom limb pain:

• Severe pain in the region prior to the amputation.
• Pain in the stump following the amputation.
• A poor fitting artificial limb

Treatment of Phantom Pain

Treatment of phantom limb pain is complex, involving a combination of any of the following:

• Modalities
• Physical therapy to decrease the sensitivity of the residual limb and to train a person to use remaining skills to overcome the impairment.
• Prosthesis
• Medications, especially neuropathic drugs and analgesics.  Neuropathic medications are drugs that decrease the firing rate of neurons and thus the pain.
• Injections can also be used to block nerves remaining in the residual limb.

Limb management after amputation is often coordinated by a Physical Medicine and Rehabilitation specialist.  These physicians are musculoskeletal experts with extensive training in management of amputations, from medication management to coordinating the team of providers involved in the complex care of these patients.  If phantom pain is a problem after an amputation, an experienced Physical Medicine pain physician may be the expert needed to help coordinate the pain management.

Have you experienced phantom limb pain? We’d love to hear your story in the comments section.