Phantom pain

The term phantom doesn't mean that the pain is imaginary. Rather, phantom pain is a real sensation that originates in your brain and spinal cord. 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.
Image: 123RF

What are the symptoms of phantom pain?

Phantom pain usually begins within the first few days of amputation or having a body part removed.

• It can be described as shooting, stabbing, throbbing, twisting, itching or burning.
• The pain comes and goes or it can be continuous. The length of time this pain lasts differs from person to person. It can last from seconds to minutes, to hours, and even to days. The symptoms of phantom limb pain can range from mild to severe. 
• It often affects the part of the limb farthest from your body, such as the foot of an amputated leg.
• The pain may be triggered by pressure on the remaining part of the limb or by emotional stress. 

Although phantom pain occurs most often in people who've had an arm or leg removed, this condition may also occur after surgeries to remove other body parts, such as the breast, penis, eye or tongue.

Triggers – things that can worsen phantom pain

Some things can make phantom pain worse, including.

• being too tired
• stress
• infection
• too much pressure on the amputated arm or leg
• an artificial limb that does not fit properly
• swelling
• poor circulation.

How is phantom pain treated?

There is no single treatment option that works for everyone. You may need to try different medications or non-medication options or a combination of both, to find one that works for you.

Self-help

There are a few things you can do to ease the pain.

• Slowly tighten and release the muscle in your limb.
• Massage your limb to stimulate the muscle and increase your circulation.
• Keep your limb warm.
• Exercise your limb.
• Change your position.
• If you have a prosthesis, take it off for a few minutes. 
• Write down when you have the phantom pain and what you were doing when it happened. This can help you find some of the things that trigger your pain. 

Medications

Medications that may be used to help relieve pain include:

• non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
• carbamazepine
• gabapentin
• amitriptyline
• nortriptyline
• opioids such as codeine or morphine
• corticosteroid or anaesthetic injections

These medications often need to be taken for a few weeks before you experience optimal pain control. If your pain does not respond to one option, your doctor may suggest changing to another medication or combining more than one medication. Read about pain relief medications.

Non-medication options

Some people find complementary therapies such as acupuncture and transcutaneous electrical nerve stimulation (TENS) helpful. Acupuncture is thought to stimulate your nervous system and relieve pain while TENS uses a small, battery-operated device to deliver electrical impulses to the affected area of your body, in order to block or reduce pain signals. Read more about non-medication treatments for pain.  

Another technique, known as mirror visual feedback, involves using a mirror to create a reflection of the other limb. Some people find that exercising and moving their other limb can help relieve the pain from a phantom limb.

Learn more

Amputation NHS Choices, UK
Phantom pain Mayo Clinic, US

References

1. A review of the management of phantom limb pain – challenges and solutions J Pain Res. 2017 Aug 7;10:1861-1870.
2. Pharmacologic interventions for treating phantom limb pain Cochrane Database Syst Rev. 2016 Oct 14.