While the exact cause of phantom limb pain in amputees is not known, there are many treatment options that are effective.
Up to 80 percent of amputees experience some level of phantom pain. While many amputees recover naturally or only experience minor sensations, some people will suffer from teeth-gritting pain for years.
This guide explores the symptoms of phantom limb pain and an overview of the various non-drug therapies available.
What is Phantom Limb Pain?
Phantom limb pain refers to ongoing painful sensations that seem to be coming from the part of the limb that is no longer there. It is thought to be caused by mixed signals from your brain or spinal cord as your nervous system adapts to limb loss.
Phantom pain affects amputees shortly after surgery and typically diminishes for most people within six months. However, some people will experience these sensations for years after losing a limb.
What Does Phantom Limb Pain Feel Like?
Phantom pain can be experienced as aching, burning, twisting, cramping, itching or pressure. For some a spell of phantom pain may last for only seconds or minutes, for others, it may last for hours or days.
What Triggers Phantom Limb Pain?
Phantom pain can affect amputees at any time, but in some cases can be triggered by certain activities or conditions. Some of the triggers of phantom limb pain include:
- Nighttime vs. daytime,
- Urination or defecation,
- Sexual intercourse,
- Cigarette smoking,
- Changes in barometric pressure,
- Herpes zoster, or
- Exposure to cold.
Treatment Options: What Does the Current Research Say?
The most effective treatments for managing phantom pain take a multipronged approach. You take medication to help reduce the pain while undergoing rehabilitation to help the nervous system adapt to the loss of the limb. As your body begins to adapt over time, you can then ease off of the medication.
One of the most promising venues for phantom limb pain treatment is visual therapy. Therapies such as the use of a mirror box or virtual reality focus on visual exercises designed to help rewire the brain to reduce the severity and duration of pain.
There have been randomized control studies that demonstrate the efficiency of visual therapy for phantom limb pain:
- A Randomized, Controlled Trial of Mirror Therapy for Upper Extremity Phantom Limb Pain in Male Amputees
- Immersive Low-Cost Virtual Reality Treatment for Phantom Limb Pain: Evidence from Two Cases
There is also some evidence that regularly wearing a prosthetic helps with phantom pain.
Other complementary therapy options such as biofeedback, TENS, or acupuncture are sometimes prescribed. Currently, the research into the effectiveness of treating phantom pain with these therapies is inconclusive.
Phantom Limb Pain Treatment Options
This post is meant to act as a guide to the various treatments available but does not constitute medical advice. You should always discuss therapy options with your healthcare team before trying them.
It was theorized by in the 90s by neurosurgeon V. S. Ramachandran that phantom limb pain results from a visual disconnect when the brain attempts to move a limb that we see is not there. He designed mirror therapy to help “trick” the brain into believing the removed limb is intact.
Although this hypothesis for the cause of phantom pain has yet to be fully proven, mirror box therapy has been shown to be effective as reducing it.
A mirror therapy box has no lid and is separated by a two-sided mirror in the middle. There are two holes in the front, and the patient inserts their intact limb into one, and their residual limb in the other.
The patient observes the reflection of their intact limb, which makes it appear that they have two intact limbs. They then perform a series of exercises where they “move” their amputated limb at the same time as they move their intact one. Although the limb is gone, using the nerves that would have moved the missing limb helps rewire the brain over time to reduce the severity of phantom pain.
Virtual Reality Therapy
Like mirror therapy, virtual reality (VR) therapy gives patients the illusion that their removed limb still exists. While the illusion of mirror therapy can be broken easily, immersive virtual reality may provide a more effective alternative. A major benefit of VR over the mirror box is the ability to move around during therapy, presenting more options for exercises.
The process uses electrodes on the residual limb to interpret signals from the brain. These signals translate into the movement of a virtual limb and allow amputees to perform all sorts of therapeutic activities in a convincing setting.
Graded Motor Imagery (GMI)
GMI is a combined visual and mental rehabilitation program that is designed for all sorts of pain and movement problems and has been shown to be effective for phantom pain. GMI uses mirror box therapy, and also works on left/right discrimination and explicit motor imagery (thinking about moving without moving) to help treat phantom pain.
Wearing Your Prosthesis
Wearing your prosthesis and regularly using your limb helps in a few ways. It can provide the same brain tricking benefits as the visual therapies listed above, and keeping the limb moving stimulates the nerves and blood flow. The contact between the prosthetic and residual limb and/or use of a shrinker sock can also help reduce phantom pain.
Some modern myoelectric prosthetics are starting to provide two-way sensory feedback. Since these sensations are similar to those provided by a natural limb, this can also reduce the impact of phantom pain.
Biofeedback uses electronic monitoring of bodily sensations to help mindfully control otherwise involuntary actions. Electrodes on the residual limb are used to recognize the physiological parameters of phantom pain such as muscle tension or heat. A therapist then works with the patient to recognize these parameters on their own, and learn techniques to control the triggers of the pain.
Transcutaneous Electrical Nerve Stimulation (TENS)
TENS uses low-voltage electric currents applied at strategic points on the body to treat pain. While the use of TENS is safe, its ability to help ease phantom pain is inconclusive.
Two different types of TENS therapy have been tried for phantom pain. Electrodes can either be placed directly on the residual limb on nerves that stimulate a phantom pain response or can be placed on the opposing intact limb.
Acupuncture / Massage Therapy
Acupuncture uses thin needles on the body to stimulate nerves, muscles and tissue. Traditional Chinese medicine suggests that acupuncture helps repair the balance of energy or “chi” throughout the body.
Some believe that acupuncture on an intact limb can help reduce phantom pain on the opposite missing limb. Similarly, some people who have gone through phantom limb pain have reported that regular massage of an intact limb has benefits for their opposite missing limb.
Want More Information on Phantom Limb Pain Therapy?
Along with consulting your healthcare team, consider reaching out to us at The Amputee Coalition. We will provide you with free up-to-date resources on phantom pain therapies and other tips to manage your recovery from amputation.