What Is Phantom Limb Pain?

When it comes to identifying types of pain, there are two types: acute and chronic. Acute pain comes on quickly, can be severe but only lasts a relatively short time. It is typically experienced after an injury or trauma, and self-resolves. 

Unlike acute pain, chronic pain is pain that lasts for a long time, and doesn't seem to get better or go away. This time period can vary but is typically defined as a three- to six-month period after symptoms begin. Chronic pain is often a debilitating symptom of many diseases and is considered a disease itself when it persists beyond recovery from an injury or illness. Chronic pain is a frequent component of many neurological disorders. 

Pain warns you that something is not quite right in your body and can cause you to take certain actions and avoid others. Pain can significantly affect your quality of life—by adversely affecting your physical and emotional well-being; upsetting relationships with family, coworkers and friends; and limiting your mobility and participation in daily activities.

Hundreds of pain syndromes or disorders make up the spectrum of pain. One cause of pain is phantom limb pain (PLP). PLP is the perception of pain or discomfort in a limb that is no longer there. Following amputation of an arm or leg, it is common to have feelings associated with the lost limb, especially within the first year of loss. 

Types of Phantom Limb Pain

PLP is often described as tingling, throbbing, sharp, pins/needles in the limb that is no longer there. It occurs more commonly in upper extremity amputations than lower extremities and tends to be intermittent in frequency. Pain severity varies, and onset can be immediate or years afterward.

Causes of Phantom Limb Pain

While little is known about the cause of phantom limb pain (PLP), it is commonly thought that the spinal cord and brain nerves continue to send pain signals due to sensing that something is wrong with that limb. Similarly, damaged nerve endings and resulting scar tissue send the same signals to the brain. 

Risk Factors for Phantom Limb Pain

Phantom limb pain is only experienced by those who have lost a limb, whether to trauma, accident or amputation.

Screening for & Preventing Phantom Limb Pain

Upon onset of symptoms, healthcare providers conduct a range of tests—including blood tests and ultrasounds—to rule out infection and other causes of limb pain. Absent of another cause, your physician will likely result in a phantom limb pain diagnosis. 

Signs & Symptoms of Phantom Limb Pain

Symptoms vary by individual. Most describe one of the following feelings emanating from the area of the missing limb:

  • Electric shock
  • Twisting sensation
  • Burning 
  • Shooting pain
  • Prickly pain, like pins and needles
  • Feeling of the limb being crushed

Other sensations reported include: 

  • Itching
  • Movement or twitching
  • Temperature change
  • Vibration
  • Pressure

Diagnosing Phantom Limb Pain

Diagnosis of PLP depends on a patient’s history and the result of various tests run to determine the cause of pain. Upon onset of symptoms, healthcare providers conduct blood tests and ultrasounds to rule out infection and other causes of limb pain. Absent of another cause, your physician will likely result in a phantom limb pain diagnosis. Diagnosis should not be confused with any or all pain that occurs after back surgery. PLP is pain that continues after surgery, whether a few days or weeks following. As scar tissue builds in the spinal nerve roots, pain can worsen for some patients and can lead to a PLP diagnosis. 

Treating Phantom Limb Pain

Physicians treating phantom limb pain (PLP) will focus on relief of symptoms. Typically prescription or over-the-counter pain relievers, like anti-inflammatories (NSAIDs). Some cases may be treated with prescription pain relievers (e.g., morphine) or antidepressants. Some studies show benefits of biofeedback, massage, physiotherapy, cognitive behavioral pain management and NMDA receptor antagonists like memantine and ketamine. 

Living with Phantom Limb Pain

Many physicians recommend exercise as an antidote for phantom limb pain, as it naturally produces endorphins, and may expedite recovery and relieve anxiety. Other treatments that don’t involve medication include acupuncture, biofeedback, transcutaneous electrical nerve stimulation (TENS) and even virtual reality therapy.