Phantom Limb Pain

What is Phantom Limb Pain?

Sometimes, when a limb is removed during an amputation, an individual will continue to have an internal sense of the lost limb. This phenomenon is known as phantom limb and accounts describing it date back to the 1800s. 

Scientists believe that following amputation, nerve cells "rewire" themselves and continue to receive messages, resulting in a remapping of the brain's circuitry. The brain's ability to restructure itself, to change and adapt following injury, is called plasticity.

What are the symptoms?

Many amputees are frequently aware of severe pain in the absent limb. Their pain is real and is often accompanied by other health problems, such as depression.

Is there any treatment?

Treatments for phantom pain may include analgesics, anticonvulsants, and other types of drugs; nerve blocks; electrical stimulation; psychological counseling, biofeedback, hypnosis, and acupuncture; and, in rare instances, surgery.

What is the prognosis?

Our understanding of phantom pain has improved tremendously in recent years. Investigators previously believed that brain cells affected by amputation simply died off. They attributed sensations of pain at the site of the amputation to irritation of nerves located near the limb stump. Now, using imaging techniques such as positron emission tomography (PET) and magnetic resonance imaging (MRI), scientists can actually visualize increased activity in the brain's cortex when an individual feels phantom pain. When study participants move the stump of an amputated limb, neurons in the brain remain dynamic and excitable. Surprisingly, the brain's cells can be stimulated by other body parts, often those located closest to the missing limb.

Related evidence

Le Feuvre P, Aldington D. Know pain know gain: proposing a treatment approach for phantom limb pain. J R Army Med Corps. 2014 Mar;160(1):16-21. doi: 10.1136/jramc-2013-000141. Epub 2013 Jul 31.

Nortvedt F, Engelsrud G. Imprisoned" in pain: analyzing personal experiences of phantom pain. Med Health Care Philos. 2014 Mar 20. [Epub ahead of print]