Man with prosthetic leg

Pain in an amputated arm. A missing leg that still itches. A foot that no longer exists but still feels numb.

It may sound like something out of science fiction, but it feels very real. Phantom limb sensations and phantom limb pain affect many amputees after their surgeries.

For some, the sensations are sporadic and minor and fade over time. Others can feel severe, chronic pain in their missing limbs.

Here’s what you should know about phantom limb sensations and phantom pain.

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What Does Phantom Pain Feel Like?

After amputation, patients can feel pain in both the portion of their limb that remains and the part that doctors amputated. Pain in the remaining limb is known as residual limb pain.

Feeling in the part of the limb that no longer exists can include both phantom pain – which can be mild or severe – and phantom sensations.

Phantom sensations include a variety of symptoms:

  • Itching
  • Tingling
  • Prickling
  • Numbness
  • Hot or cold
  • Feeling like the missing limb is still there:
  • Telescoping: Feeling like the limb is shrinking
  • Feeling like the missing limb is moving

Nearly all amputation patients feel some phantom sensations afterward, says Michael Munin, MD.

“Usually, it’s just an odd sensation that a body part is still there,” says Dr. Munin, professor in the  Department of Physical Medicine and Rehabilitation at the University of Pittsburgh School of Medicine.

Phantom pain can take on many forms, including burning, throbbing, cramping, stabbing, pressure, or an electric shock feeling.

According to the Amputee Coalition, about 80 percent of amputees feel phantom pain.

Phantom pain and phantom sensations can be intermittent, fading after seconds or minutes. A smaller percentage of people report feeling chronic phantom pain.

People also can feel phantom sensations in other parts of the body, including the breast, nose, penis, bowel, eyes, teeth, tongue, and bladder.

What Causes Phantom Pain?

Knowledge of phantom pain and phantom sensations dates back centuries.

Ambrose Pare, a 16th-century French military surgeon, first described the condition of pain in a part of the body that was no longer there. Silas Weir Mitchell, a surgeon in the Civil War, named that condition “phantom limb pain” during the 19th century.

While the exact cause of phantom sensations and pain is unknown, the condition appears to come from changes in your neurological system.

The brain’s sensory cortex normally receives signals from the spinal cord about where body parts are and how they’re moving and records sensations. Studies of post-amputation patients show changes in the brain maps, Dr. Munin says.

“We know that it’s a neurological pathway driven issue,” Dr. Munin says. “It’s the memory in the brain of the missing body part that the patient’s experiencing abnormal sensations.”

How Is Phantom Pain Treated?

Doctors can treat phantom pain with several different options.

  • Medication: Various types of medicines can treat phantom pain. Those include:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin and ibuprofen
    • Acetaminophen (Tylenol)
    • Antiseizure medicines
    • Antidepressants
    • Lidocaine
    • Opioids: These can cause significant side effects and potential addiction.
  • Mirror therapy: In mirror therapy, patients place their intact limb in front of a mirror. They move their intact limb; when reflected in the mirror, it appears the missing limb is moving. Studies showed some patients felt less phantom pain after mirror therapy.
  • Virtual reality: Like mirror therapy, using technology to create virtual images of missing limbs has helped some patients with phantom pain.
  • Transcutaneous electrical nerve stimulation (TENS): A treatment that uses electrodes to send electric current to nerves, stimulating them.
  • Desensitization exercises: Doctors work with patients to create an image of the missing limb in their mind and work to treat the pain mentally. “If the leg feels cramped, the toes are cramped, we work with the patient to uncurl their toes, for example, with their mind,” Dr. Munin says.

Other potential treatments, some of which can happen outside the hospital, include acupuncture, massage, and exercise of the remaining limb. A prosthetic limb also can help.

“The use of a prosthesis, that contact support, often is useful in mitigating phantom sensation and occasional pain,” Dr. Munin says.

Does Phantom Pain Go Away?

While almost all amputees feel some level of phantom sensations or pain, the condition usually gets better over time.

Dr. Munin says the body usually adapts to the missing limb eventually; how long it takes depends on the patient.

“They become better able to deal with any pain sensations that they have in the missing limb,” Dr. Munin says.

Some patients do develop chronic phantom limb pain, requiring ongoing treatment for their symptoms. “Unfortunately, there are patients like that, but luckily it’s a minority of cases,” Dr. Munin says.

Associated conditions with phantom pain include:

  • Heterotopic ossification: A condition that develops when bony spikes can grow out of a cut bone, causing pain.
  • Neuromas: The thickening of a nerve near amputation site, these can cause pain with pressure or contact. They can make it difficult to fit a prosthesis; surgeons may have to remove them.

To schedule an appointment with a doctor at the Department of Physical Medicine and Rehabilitation, call 1-800-533-8662 (UPMC).

Sources
Managing Phantom Pain . Amputee Coalition. Kassondra L. Collins, Hannah G. Russell, Patrick J. Schumacher, Katherine E. Robinson-Freeman, Ellen C. O’Conor, Kyla D. Gibney, Olivia Yambem, Robert W. Dykes, Robert S. Waters, Jack W. Tsao. A Review of Current Theories and Treatments for Phantom Limb Pain . Journal of Clinical Investigation. Sacha B. Finn, Briana N. Perry, Jay E. Clasing, Lisa S. Walters, Sandra L. Jarzombek, Sean Curran, Minoo Rouhanian, Mary S. Keszler, Lindsay K. Hussey-Andersen, Sharon R. Weeks, Paul F. Pasquina, Jack W. Tsao. A Randomized, Controlled Trial of Mirror Therapy for Upper Extremity Phantom Limb Pain in Male Amputees . Frontiers in Neurology. Aaron A. Hanyu-Deutmeyer; Marco Cascella; Matthew Varacallo, StatPearls. Phantom Limb Pain . Laxmaiah Manchikanti, Vijay Singh, Mark V.Boswell. Pain Management. Pain Management. Ali Kemal Şehirlioğlu, Cagatay Ozturk, Kamil Yazıcıoğlu, Ilknur Tuğcu, Bilge Yılmaz, Ahmet Salim Goktepe. Painful Neuroma Requiring Surgical Excision After Lower Limb Amputation Caused by Landmine Explosions. International Orthopaedics. Bishnu Subedi and George T. Grossberg. Phantom Limb Pain: Mechanisms and Treatment Approaches. Pain Research and Treatment. Phantom Limb Pain . U.S. National Library of Medicine.

About Physical Medicine and Rehabilitation

The UPMC Department of Physical Medicine and Rehabilitation, we strive to improve your function after injury or illness. We treat functional, pain-related, and neurological conditions, helping with both physical and emotional disorders. We provide inpatient therapy at the UPMC Rehabilitation Institute, and we also operate several outpatient clinics throughout western Pennsylvania. We also are a leader in research to develop new technologies and tools for the highest quality care.