Many people facing or recovering from an amputation have heard about “phantom limbs”—sensations and pain that seem to originate from the missing body part. It all sounds a little spooky, which may be why many people fear phantom limb pain, says Nathan McKenty, M.D., a physical medicine and rehabilitation doctor at Henry Ford Health. But the reality isn’t usually as bad as they imagine.
“Phantom sensations are common after losing a limb, but they’re often not as problematic as people fear,” he says. “We have a variety of tools we can use to prevent and treat phantom limb pain.”
Dr. McKenty explains where phantom limb sensations come from and how they’re managed.
What Causes Phantom Limb Pain?
For most people who have lost a limb to amputation, phantom sensations arise as soon as the anesthesia wears off, Dr. McKenty says. “They feel like the limb is still there, but it’s not necessarily painful,” he explains. “They’re caused by your brain trying to interpret your body map.”
As babies grow, their brains learn to sense where their bodies are in space. Thanks to that body map, you can sense your feet beneath you when you walk and feel where your hand is when you reach to grasp an object.
When you lose a limb, your brain suddenly stops receiving signals from that hand or foot. “Your brain is trying to make sense of that absence, and that confusion is sometimes perceived as pain,” Dr. McKenty says.
Interestingly, children who have an amputation are less likely to develop phantom limb sensations, since their brain hasn’t finished building their body map yet. In adults, a sensation that the limb is still in place is common, and often lasts for years—sometimes permanently.
Alongside those sensations, some phantom limb pain isn’t uncommon. But it often improves within a year or two as the brain builds a new body map. Luckily, phantom limb pain is usually not debilitating. “Many people experience phantom limb pain as a flash of discomfort that lasts for a few seconds,” Dr. McKenty says.
Though it’s less common, some amputees develop significant chronic phantom limb pain, which can be challenging to manage. People who experienced chronic pain in the limb before amputation—such as people who had preexisting nerve pain caused by diabetes, for instance—are at increased risk of developing more persistent phantom pain after amputation.
Where Does Phantom Limb Pain Come From?
When someone is experiencing pain in an amputated arm or leg, the first step is to figure out where it’s coming from, Dr. McKenty says. Though they are often confused, there are actually two distinct sources of pain:
- Residual limb pain is pain or discomfort that arises from the remaining portion of the limb. It can be caused by physical problems such as infection, poor blood supply, bone spurs or a poorly fitting prosthetic.
- Phantom limb pain seems to originate from the missing space where the amputated limb used to be. “It’s important to distinguish the difference, because the way we treat them can be quite different,” Dr. McKenty says.
Phantom Limb Pain Treatment
Treatments for residual limb pain focus on addressing the underlying cause—such as improving the fit of a prosthetic or treating tissue damage in the remaining limb.
True phantom limb pain can be treated in a variety of ways:
Amputee Clinic at Henry Ford Health
Postoperative care
The best treatment is prevention. Controlling pain after amputation helps prevent the brain from getting stuck in a negative pattern, mapping pain signals where the limb used to be. Good post-surgical care should include efforts to control pain, reduce swelling, and avoid re-injuring the remaining limb.
Physical therapy
Physical therapy is standard after amputation. Therapy should include desensitizing the limb by rubbing, tapping and touching it, as well as exposing it to different textures, Dr. McKenty says. “That touch helps your brain relearn the boundaries of your new limb,” he adds.
Mirror therapy
This treatment uses a mirror placed between the existing limb and the amputated limb. Patients perform movements with their remaining arm, while the mirror makes it look as if they were using the affected arm. The therapy, which is standard for many amputation patients, helps trick the brain into thinking it has control over the missing limb.
Physical adjustments
For a lot of patients, a compression sock or sleeve on the residual limb can reduce a lot of phantom sensation, Dr. McKenty says. Making sure prosthetics fit well and don’t rub is also important.
Medications
A variety of medications are used to control phantom limb pain, including pain relievers like acetaminophen and anti-inflammatories, topical creams, medications for nerve pain and injections to block nerve activity. “Sometimes people develop swellings called neuromas around the cut ends of nerves after an amputation,” Dr. McKenty says. “Treating those neuromas with medications or injections can often help a lot.”
Surgery
Newer surgical procedures are also available to treat phantom limb pain. These procedures wrap the loose end of a cut nerve in some muscle tissue or connect it to muscle in the remaining limb.
“Idle nerves cause problems,” Dr. McKenty explains. “By attaching it to muscle, it gives it a job to do and also helps to prevent neuromas from forming.”
Increasingly, these surgical techniques are being done at the time of amputation to prevent problems later on. “I’m hopeful that they will become standard in every amputation,” Dr. McKenty says. But if the procedure was not done during the initial amputation, he adds, patients experiencing phantom limb pain can have a second surgery later to reattach the loose nerve endings.
Treatment is rarely one-size-fits-all, so people with phantom pain may need to explore a few strategies to control their discomfort. “But the important takeaway is that there are a lot of options we can try if you’re dealing with pain,” Dr. McKenty says.
Reviewed by Nathan McKenty, M.D., a physical medicine and rehabilitation doctor at Henry Ford Health.
