What Is Phantom Pain?

Despite its name, phantom pain is a real, painful sensation that some amputee patients feel in a part of their body that no longer exists. The part of the body that is removed through amputation (surgically cutting off a limb) is referred to as a phantom limb. It may even feel like the phantom limb is still attached to your body. This condition affects up to 80 percent of people with amputation. However, it can be reliably treated so that most people experience a significant decrease in pain within two years of their amputation surgery.

Signs of Phantom Pain

You may experience phantom pain soon after your amputation or even in the weeks or months afterward. The pain in the missing limb may be ongoing or unpredictable. It is often worse at night when your thoughts turn inward as outside distractions subside.  You may feel pain that is:

  • sharp,
  • throbbing,
  • pins and needles,
  • burning, or
  • similar to cramps.

The pain often feels as if it is located in the part that is the greatest distance from your healthy body. For example, after a leg amputation, the foot (which is no longer there) may feel phantom pain.

What Causes Phantom Pain?

Researchers are continually investigating additional causes and treatments for this unique phenomenon. However, they have discovered that phantom limb pain could be caused by a miscommunication between your brain, spinal cord, and nerves that continues after your amputation.

Other causes that can worsen pain may include: 

  • stress,
  • anxiety,
  • depression, and
  • pain in the limb prior to amputation.

Patients who experience pain in the limb before amputation often report phantom limb pain afterward in a similar way. Your doctor will make every effort to decrease your pain before surgery to lessen the chance of discomfort afterward. Additional pain management in the weeks after surgery can dramatically decrease your pain.

Find a Rehabilitation Specialist

Phantom Pain Treatment

Alleviating phantom pain is possible. Many patients find significant relief through:

  • nonsteroidal anti-inflammatory drugs (NSAIDS),
  • nerve pain medications from a variety of classes, including antidepressants; anti-seizure medication;, and blood pressure medications,
  • desensitization (a home remedy that reduces hypersensitivity after an amputation),
  • behavioral strategies,
  • referrals to a rehabilitation psychologist,
  • injections, and
  • surgery.

For some patients, wearing a prosthetic (artificial limb) more frequently helps decrease the level of pain. This is especially true in amputations of the hand and arm.

Phantom Pain Medication

Our physicians are committed to diagnosing the source of the pain to best address your symptoms. A spectrum of pharmaceutical options are available. Your physician will use opiates only when needed and taper them appropriately. Neuropathic medications and injections can also address specific and wider nerve pain.

Phantom Pain Remedies to Do at Home

For some patients, standard relaxation techniques help reduce their pain including gentle massage and listening to music. Our clinicians and therapists may also recommend other at-home approaches including:

Mirror Treatment

You can use a device called a mirror box with separate openings for your healthy body part and residual (remaining) limb. We provide mirror boxes for our patients on a case-by-case basis. However, you may order one online or ask your insurance company if they will cover the cost.

You can do this at home using the following instructions:

  1. Place a mirror in the middle of your body to reflect your healthy leg or arm (or situate it to reflect whichever healthy body part you want to look at).
  2. When you look in the mirror, it should now appear that you have two healthy arms or legs.
  3. Practice doing movements with the healthy part of your body every day. You should be able to see your intact body part and the reflection.
Over time, many patients have seen a reduction in their pain.

Desensitization

If you experience hypersensitivity after amputation, your doctor may recommend this technique.

  1. Rub material with a smooth texture over your skin on the residual (remaining) limb. Begin lightly and go in multiple directions.
  2. Do this for several minutes a few times each day. You may feel some pain, itchiness, or discomfort.
  3. When you stop the movement, the feeling should cease or decrease.
  4. After a while, you can increase the pressure and change the texture of the material. A material such as corduroy or wool will feel rougher on your skin.
  5. Over time, the sensitivity of your skin may decrease, which helps to decrease your pain and makes it easier to use a prosthetic.

Does Phantom Pain Ever Go Away?

Phantom pain does eventually go away with time. Many people find their pain has decreased by about 75 percent or more within two years after amputation surgery. If it does return, talk to your doctor. There may be an underlying problem — such as a neuroma (nerve overgrowth) — triggering the sensation.

Residual Limb Pain vs. Phantom Pain

After an amputation, some patients may feel pain in the remaining or residual limb. It is even possible for patients to feel residual limb pain (a non-bothersome sensation originating in the space where the limb used to be) and phantom pain at the same time.

The cause of your residual limb pain may be:

  • infection,
  • blood supply issues,
  • referred pain,
  • muscle strain,
  • neuroma or other nerve problems,
  • bone fractures, and
  • skin issues.

Residual Limb Pain Treatment

Managing this kind of pain may include:

  • over-the-counter pain relievers and some stronger medications,
  • antidepressants (off-label use for increasing neurotransmitters that reduce the perception of pain),
  • physical and occupational therapy,
  • injections, and
  • electrical stimulation.

Residual Limb Surgery

Occasionally, a residual limb (the remaining portion of the limb after amputation) has a shape, skin, nerve, or bone problem that can only be resolved with surgery. In these cases, our surgeons can reconstruct the residual limb for optimal success with a prosthetic. 

We use the most advanced techniques to restore strength, function, control, and avoid pain. One such approach is targeted muscle reinnervation (TMR) surgery where we split the ends of the nerves and place them into new muscles where they will grow into new muscle. This surgical procedure will prevent pain and allow robotic limbs to read signals from the muscles.

Another advanced and emerging technique we are studying is osseointegration. This is when a surgeon implants a titanium rod in your healthy bone to attach a prosthetic. The result is a lighter, stronger, and more natural artificial leg. Currently, University of Utah and the Veteran’s Administration are studying these implanted devices in the United States in hopes of gaining FDA (Food Drug Administration) approval and broader application.

Amputee Support Groups

We offer a monthly support group for amputees, their family, and caregivers. 

Date & Time
Fourth Tuesday of every month (except July) at 7pm

Location
Sugar House Health Center
1280 East Stringham Avenue,
Salt Lake City, UT 84106

For more information, contact Spencer Thompson at spencer.thompson@hsc.utah.edu to confirm dates and times of upcoming meetings.

Meet with Our Amputee Program Specialists

For questions or information on how to meet with our specialists or join our amputee inpatient program at the Craig H. Neilsen Rehabilitation Hospital, please call our referral line at 801-646-8000. Our referral specialist will work with your current provider to obtain necessary medical records and verify your insurance benefits for coverage.

For outpatient physician clinic questions, call 801-581-2267. For information about Sugar House Therapy Services, call 801-581-2221.