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Definition

Phantom limb syndrome is the feeling of sensations in a limb that has been removed. There may be feelings in the limb as if it were still attached to their body. This is because the brain continues to get messages from nerves that used to "feel" for the missing limb.

Nervous System
CNS and PNS

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Causes

The exact cause of phantom limb syndrome is unknown. It is thought that the sensations are due to the brain’s attempt to reorganize signals. The brain must rewire itself to adjust to the changes in the body.

Risk Factors

Phantom limb syndrome is more common in adults than in children. Other factors that may increase your chance of developing phantom limb syndrome include:

  • Preamputation pain
  • A blood clot in the amputated limb
  • Preamputation infection
  • Previous damage to spinal cord or peripheral nerves that supplied the affected limb
  • Sudden, unexpected amputation (such as accident instead of planned surgery)
  • Type of anesthesia used during the amputation

Symptoms

The symptoms are felt in a limb that does not exist. Phantom limb syndrome may cause sensations of:

  • Shooting, stabbing, piercing, or burning pain
  • Pleasure such as a light touch
  • Pressure and feeling of clothing or jewelry
  • The limb still being attached and working normally
  • Numbness, tickling, or cramping

Diagnosis

It is important to tell your care team if you have pain or other sensation after limb loss. Earlier treatment may improves the chances of success.

There is no medical test to diagnose phantom pain. You will be asked about your past health. A physical exam will be done. The doctor will want to know about the signs and symptoms. You may be asked about the amputation. Diagnosis can be made based on your symptoms.

Treatment

Phantom limb syndrome is often brief. It can pass on its own over time. Others may have persistent pain. Treatment can be challenging for them. There is no one treatment plan that is best. Treatment will be chosen to help control specific symptoms. Options include:

Medicine

Symptoms may be managed with medicine such as:

  • Antidepressants
  • Anticonvulsants
  • Antipsychotics
  • Prescription pain medication
  • Muscle relaxers

Electrical Nerve Stimulation

Electrical nerve stimulation may help calm nerve signals. Examples include:

  • Transcutaneous electrical nerve stimulation (TENS)—a tiny electric current is sent through the skin to nearby nerves
  • Transcranial magnetic stimulation—a strong magnetic pulse is sent through the scalp into the brain
  • Spinal cord stimulation—an electrode is inserted near the spinal cord to relieve pain

Other Approaches

The following have not shown consistent benefits. However, they may help with some symptoms.

  • Regional sympathectomy—a surgical procedure that interrupts selected nerves near the spinal cord
  • Meditation and relaxation techniques
  • Biofeedback
  • Hypnosis
  • Acupuncture
  • Massage
  • Exercise

Prevention

Research is ongoing to better understand phantom limb syndrome. There are no clear answers for prevention right now.

RESOURCES:

Amputee Coalition of America
http://www.amputee-coalition.org

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov

CANADIAN RESOURCES:

Amputee.ca
http://www.amputee.ca

The War Amps of Canada
http://www.waramps.ca

REFERENCES:

Chahine L, Kanazi G, et al. Phantom limb syndrome: A review. Middle East J Anesthesiol. 2007;19(2):345-355.

Richardson C, Kulkarni J. A review of the management of phantom limb pain: challenges and solutions. J Pain Res. 2017;10:1861-1870.

Subedi G, Grossberg G. Phantom Limb Pain: Mechanisms and Treatment Approaches. Pain Res Treat. 2011; 2011: 864605. PMID: 22110933

Weeks SR, Anderson-Barnes VC, et al. Phantom limb pain: Theories and therapies. 2010;16(5):277-286.

Last reviewed January 2019 by EBSCO Medical Review Board Monica Zangwill, MD, MPH  Last Updated: 1/8/2019