Introduction

Phantom limb pain is a real condition that occurs in some people after the amputation of an arm or leg. People with phantom limb feel pain as if the amputated limb is still there. The exact mechanism of phantom limb pain is not well known, but it appears to be related to the way nerve signals are processed in the brain. There are several different types of treatment to relieve symptoms, and researchers are investigating ways to prevent the condition.

Anatomy

The brain and nerves throughout the body transmit information to each other in a complex manner. The brain processes many nerve signals for pain, temperature, touch, and body positioning all the time. When a limb or part of a limb is amputated, the nerves are surgically cut and the nerve transmission is disrupted. Eventually the nerve endings heal.

Causes

Phantom limb pain is not imaginary. It is a real condition with a real physical cause. Researchers have used sophisticated brain mapping techniques to demonstrate that the pain that people with phantom limb pain feel is real. The exact cause of phantom limb pain is unknown. It appears that after an arm or leg is amputated the nerves and memories in the brain send faulty signals as the circuitry attempts to “rewire” itself.

Symptoms

Phantom limb pain is pain that occurs where the amputated limb once was. The pain may be throbbing, shooting, stabbing, burning, or squeezing. The pain is commonly felt in the farthest place from the body; for example, in the foot of an amputated limb. The pain typically comes and goes.

Diagnosis

Although there is no specific test for phantom limb pain, a doctor can make the diagnosis by reviewing your medical history and conducting an examination. Your doctor will ask you to describe your pain in detail to help differentiate it from stump pain, a separate condition.

Treatment

There are a variety of treatments for phantom limb pain. It is rather common to try more than one type of treatment before discovering what works the best for you. Treatment may include medications such as antidepressants, anticonvulsants, and narcotic pain medication. Pain management therapies such as nerve stimulation (TENS), spinal cord stimulation, acupuncture, medication injections, or implanted medication pumps can help. In rare cases, surgery is used for stump revision or deep brain stimulation.

Prevention

Researchers are studying the use of medications before surgery (Calcitonin) and after surgery (Ketamine) to help prevent phantom limb pain. Investigators hope that these medications will be successful, but more research is needed.

Am I at Risk

You may be at risk for phantom limb after an amputation. People with pain before amputation, stump pain after amputation, or poor-fitting artificial limbs (prostheses) may have a higher risk for phantom limb pain.

Advancements

Researchers are studying the effectiveness of using mirrored boxes with therapy, artificial limbs with electrical signals, and virtual reality goggles that have demonstrated to help some people.