What is phantom pain?
Phantom pain is pain that feels like it’s coming from a body part that’s no longer there. Doctors once believed this post-amputation phenomenon was a psychological problem, but experts now recognize that these real sensations originate in the spinal cord and brain.
Although phantom pain occurs most often in people who’ve had an arm or leg removed, the disorder may also occur after surgeries to remove other body parts, such as the breast, penis, eye or tongue.
For some people, phantom pain gets better over time without treatment. For others, managing phantom pain can be challenging. You and your doctor can work together to treat phantom pain effectively with medication or other therapies.
How common is phantom pain?
Please discuss with your doctor for further information.
What are the symptoms of phantom pain?
Most people who’ve had a limb removed report that it sometimes feels as if the amputated limb is still there. This painless phenomenon, known as phantom limb sensation, may rarely occur in people who were born without limbs.
Phantom limb sensations may include feelings of coldness, warmth, or itchiness or tingling — but should not be confused with phantom pain. Similarly, pain from the remaining stump of an amputated limb is not phantom pain. By definition, phantom pain feels as if the pain comes from a body part that no longer remains.
Characteristics of phantom pain include:
- Onset within the first few days of amputation
- Comes and goes or is continuous
- Often affects the part of the limb farthest from the body, such as the foot of an amputated leg
- May be described as shooting, stabbing, boring, squeezing, throbbing or burning
- Sometimes feels as if the phantom part is forced into an uncomfortable position
- May be triggered by pressure on the remaining part of the limb or emotional stress
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes phantom pain?
Researchers don’t know exactly what causes phantom limb pain. One possible explanation: Nerves in parts of your spinal cord and brain “rewire” when they lose signals from the missing arm or leg. As a result, they send pain signals, a typical response when your body senses something is wrong.
Another example of this rewiring: When you touch one body part — say, your hip or your forearm — your brain might sense it on your missing limb.
Other possible causes of phantom limb pain include damaged nerve endings and scar tissue from the amputation surgery.
What increases my risk for phantom pain?
There are many risk factors for phantom pain, such as:
- Pain before amputation. Some researchers have found that people who had pain in a limb before amputation are likely to have it afterward, especially immediately after amputation. This may be because the brain holds on to the memory of the pain and keeps sending pain signals, even after the limb is removed.
- Stump pain. People who have persistent stump pain usually have phantom pain, too. Stump pain can be caused by an abnormal growth on damaged nerve endings (neuroma) that often results in painful nerve activity.
- Poor-fitting artificial limb (prosthesis). Talk to your doctor to be sure you’re putting your artificial limb on correctly and that it fits properly. If you think your artificial limb may not fit properly, or is causing pain, talk to your doctor.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is phantom pain diagnosed?
Although there’s no medical test to diagnose phantom pain, doctors can identify the condition by collecting information about your symptoms and the circumstances, such as trauma or surgery, which occurred before the pain started.
Describing your pain precisely can help your doctor pinpoint your problem. Even though it’s common to have phantom pain and stump pain at the same time, treatments for these two problems may differ.
How is phantom pain treated?
Finding a treatment to relieve your phantom pain can be difficult. Doctors usually begin with medications and then may add noninvasive therapies, such as acupuncture or transcutaneous electrical nerve stimulation (TENS).
More-invasive options include injections or implanted devices. Surgery is done only as a last resort.
Although no medications specifically for phantom pain exist, some drugs designed to treat other conditions have been helpful in relieving nerve pain.
No single drug works for everyone, and not everyone benefits from medications. You may need to try different medications to find one that works for you.
Medications used in the treatment of phantom pain include:
- Tricyclic antidepressants may relieve the pain caused by damaged nerves. Examples include amitriptyline, nortriptyline (Pamelor) and tramadol (Conzip, Ultram). These drugs work by modifying chemical messengers that relay pain signals. Antidepressants may also help you sleep, which can make you feel better. Possible side effects include sleepiness, dry mouth, blurred vision, weight gain, and a decrease in sexual performance or desire.
- Epilepsy drugs — such as gabapentin (Gralise, Neurontin), pregabalin (Lyrica) and carbamazepine (Carbatrol, Epitol, Tegretol) — are often used to treat nerve pain. They work by quieting damaged nerves to slow or prevent uncontrolled pain signals. Side effects may include depression, anxiety, suicidal thoughts, irritability, and allergic reactions such as hives, fever and swelling.
- Opioid medications, such as codeine and morphine, may be an option for some people. Taken in appropriate doses under your doctor’s direction, they may help control phantom pain. However, you may not be able to take them if you have a history of substance abuse. Even if you don’t have a history of substance abuse, these drugs can cause many side effects, including constipation, nausea, vomiting or sedation.
- N-methyl-d-aspartate (NMDA) receptor antagonists. This class of anesthetics works by binding to the NMDA receptors on the brain’s nerve cells and blocking the activity of glutamate, a protein that plays a large role in relaying nerve signals. In studies, NMDA receptor antagonists ketamine and dextromethorphan were effective in relieving phantom pain. Side effects of ketamine include mild sedation, hallucinations or loss of consciousness. No side effects were reported from the use of dextromethorphan.
As with medications, treating phantom pain with noninvasive therapies is a matter of trial and observation. The following techniques may relieve phantom pain:
- Nerve stimulation. In a procedure called transcutaneous electrical nerve stimulation (TENS), a device sends a weak electrical current via adhesive patches on the skin near the area of pain. This may interrupt or mask pain signals, preventing them from reaching your brain. Used properly, TENS is safe. To avoid an unintentional shock, don’t wear a TENS device in the shower or tub or turn it up too high.
- Mirror box. This device contains mirrors that make it look like an amputated limb exists. The mirror box has two openings — one for the intact limb and one for the stump. The person then performs symmetrical exercises, while watching the intact limb move and imagining that he or she is actually observing the missing limb moving. Studies have found that this exercise may help relieve phantom pain.
- The National Institutes of Health has found that acupuncture can be an effective treatment for some types of chronic pain. In acupuncture, the practitioner inserts extremely fine, sterilized stainless steel needles into the skin at specific points on the body. It’s thought that acupuncture stimulates your central nervous system to release the body’s natural pain-relieving endorphins. Acupuncture is generally considered safe when performed correctly.
Minimally invasive therapies
- Sometimes injecting pain-killing medications — local anesthetics, steroids or both — into the stump can provide relief of phantom limb pain.
- Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord can sometimes relieve pain.
- Nerve blocks. This method uses medications that interrupt pain messages between the brain and the site of the phantom pain.
Surgery may be an option if other treatments haven’t helped. Surgical options include:
- Brain stimulation. Deep brain stimulation and motor cortex stimulation are similar to spinal cord stimulation except that the current is delivered within the brain. A surgeon uses a magnetic resonance imaging (MRI) scan to position the electrodes correctly. Although the data are still limited, brain stimulation appears to be a promising option in selected individuals.
- Stump revision or neurectomy. If phantom pain is triggered by nerve irritation in the stump, surgical resection or revision can sometimes be helpful. But cutting nerves also carries the risk of making the pain worse.
On the horizon
Newer approaches to relieve phantom pain include virtual reality goggles. The computer program for the goggles mirrors the person’s intact limb, so it looks like there’s been no amputation. The person then moves his or her virtual limb around to accomplish various tasks, such as batting away a ball hanging in midair. Although this technique has been tested on only a few people, it appears to help relieve phantom pain.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage phantom pain?
The following lifestyles and home remedies might help you cope with phantom pain:
- Look for distractions. Find activities that take your focus off the pain, such as reading or listening to music.
- Stay physically active. Get your exercise by doing activities that you enjoy, such as gardening, walking, swimming or cycling.
- Take your medications. Follow your doctor’s directions in taking prescribed and over-the-counter pain medications. If you try herbal and other alternative medications, be sure to tell your doctor.
- Find ways to relax. Practice activities that reduce your emotional and muscular tension. Take a warm bath — not too hot, as heat may aggravate the pain. Lie down and follow helpful relaxation techniques, such as rhythmic breathing, meditation or visualization.
- Seek the support of other people. Find ways to get closer to others. Call friends, or join a support group or a group involved in your favorite hobby.
- Take care of your stump. Removing or putting on your prosthesis, massaging the stump, and applying TENS, cold or heat may reduce the pain.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Phantom pain. http://www.mayoclinic.org/diseases-conditions/phantom-pain/basics/definition/con-20023268. Accessed July 28, 2017.
What Is Phantom Limb Pain? http://www.webmd.com/pain-management/guide/phantom-limb-pain#1. Accessed July 28, 2017.
Review Date: July 28, 2017 | Last Modified: July 31, 2017