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Phantom limb pain is the sensation of pain in a limb that has been amputated. It is a type of chronic pain that can affect people who have undergone an amputation, and it can range in intensity from mild to severe. The pain is often described as a shooting, stabbing, or burning sensation, and it can be localized to the area where the limb was amputated or it can be felt throughout the body. Phantom limb pain can be difficult to treat and may require a combination of medications, physical therapy, and other therapies to manage the pain. It is important for people experiencing phantom limb pain to work with their healthcare team to find the most effective treatment plan. An estimated 85% of people who have lost a limb will experience phantom limb pain.
Understanding Phantom Limb Pain & Neuroma
What is Phantom Limb Pain?
Symptoms
Phantom limb pain usually begins shortly after surgery. The amputee might feel pain where the missing limb should be. The pain can occur within the first week of the amputation or can be delayed for months after. Phantom limb pain is commonly described as:
- Shooting
- Stabbing
- Cramping
- Burning
- Pins and needles
- Throbbing
Causes
While the exact cause of phantom limb pain is unknown, many experts believe that the pain can be a response to mixed signals from the brain. When a body part is missing, this can cause the brain to signal that something is not right, which, in turn, can cause the brain to misinterpret the information it receives, processing signals as sensations of pain.
A neuroma can also contribute to phantom limb pain. During an amputation, the nerves that send information between that limb and the brain are severed. The end of those severed nerves can sometimes grow into a disorganized mass known as a neuroma. A neuroma can send confusing signals to the brain, leading to pain and discomfort and limited motion for the patient. Neuroma symptoms can include:
- Tingling sensations
- Tender to the touch
- Shooting sensation from a prosthetic
Risk Factors
The risk factors for developing phantom limb pain include the following:
- Age: Phantom limb pain is more common in older adults.
- Type of amputation: Phantom limb pain is more likely to occur after lower limb amputations, particularly those that involve the knee or ankle.
- Level of amputation: Phantom limb pain is more likely to occur after higher-level amputations, such as those that involve the thigh or hip.
- Previous pain: People who have experienced chronic pain in their limb prior to amputation may be at higher risk for developing phantom limb pain.
- Psychological factors: People who have high levels of anxiety or depression may be more likely to experience phantom limb pain.
- Quality of surgical technique: Poorly performed amputations or those that result in nerve damage may increase the risk of developing phantom limb pain.
- Duration of pre-amputation pain: The longer a person experiences pain before an amputation, the more likely they are to experience phantom limb pain.
Testing and Diagnosis
Phantom limb pain is diagnosed based on the patient's self-report of pain in a limb that has been amputated. It is important that providers listen carefully to the patient's description of the pain and how it feels. Your provider may also ask questions about your medical history, including the type and level of amputation, any previous pain in the limb, and overall health.
In some cases, additional tests may be conducted to rule out other potential causes of the pain, such as nerve damage or infection. These tests may include imaging studies, such as X-rays or MRI scans, or nerve conduction studies.
Phantom Pain Treatment
Early diagnosis and treatment can help to reduce the severity and frequency of phantom limb pain and improve the patient's quality of life. Phantom pain can be treated in several ways. What works for one person might not work for another. An amputee may also need to try different treatments before they find success. Treatments available to patients can range from medications and therapy to surgical treatment options. Your doctor may recommend a combination of treatments.
Conservative Phantom Limb Pain Treatments
Non-invasive options for treating phantom limb pain may include:
Medications: Some over-the-counter or prescription pain medications have been found to help manage phantom limb pain. Your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs), topical medications to block pain receptors or prescription medications for pain and inflammation.
Mirror Therapy: With this therapy, the patient will view the intact limb through a mirror while exercising and moving. Over time, the brain can reprogram to think there are two limbs, thus reducing or eliminating phantom pain.
Complementary Therapies: Complementary therapies are treatments you may receive alongside traditional medicine, and can include:
- Acupuncture
- Biofeedback
- Massage
- Meditation
- Music therapy
- Surgical Phantom Limb Pain Treatments
If non-invasive treatment options have failed or aren’t providing adequate relief from pain in an amputated limb, surgical options are available. At the Institute for Advanced Reconstruction, we help patients suffering from phantom limb pain with targeted muscle reinnervation surgery.
TMR Surgery: Targeted muscle reinnervation (TMR) surgery is a procedure that transfers nerves that were once in control of the amputated limb to restore function to nearby muscles. TMR surgery differs from the standard surgical procedure for phantom limb pain. Instead of just excising (removing) the affected nerve and burying it into an adjacent muscle, which can open the door for future neuromas to form, a TMR surgery reinnervates the affected nerve. By encouraging the nerve to reinnervate in an organized fashion, attaching and restoring function to a nearby muscle, it prevents the disorganized nerve regeneration that can lead to a neuroma and phantom limb pain.
TMR surgery can occur at the same time as or after an amputation to prevent neuromas from forming and causing phantom limb pain. TMR can also help with prosthetics, making them more comfortable and improving your ability to use and control them.
TMR surgery takes about two to four hours and can require a hospital stay of up to five days. After the procedure, most patients will experience surgery-related pain but no nerve pain. The nerves will regenerate or “wake up” soon after surgery, causing an increase in pain. Your doctor may prescribe pain management medication; however, the need for medicine should decrease as the nerves heal.
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Patient Stories
Are you trying to imagine a future without phantom limb pain? Find out how our patients have found a new quality of life after TMR surgery.
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Insurance Information
The Institute for Advanced Reconstruction participates in a wide range of insurance plans, including those listed below. However, each physician has their own accepted insurance and hospital affiliations. Before scheduling an appointment, please contact your insurance carrier to confirm that your provider is in-network.
If we are not an in-network provider, our friendly insurance specialists will help you find the most coverage available for your treatment.
- Horizon Blue Cross Blue Shield of New Jersey
- Medicare
- Railroad Medicare
- Aetna
- Cigna
- United Healthcare
- Oxford (Freedom, Liberty)
- MagnaCare
Patient Resources
Learn more about what to expect when it comes to surgical procedures and treatments at the Institute for Advanced Reconstruction by visiting our patient resource page.
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Schedule an appointment today and find out if TMR surgery is an option for treating your phantom limb pain.