FAQs on Phantom Limb Pain from a Top Arizona Pain Center

According to statistics, around 1.7 million patients in the U.S. have undergone limb amputation. Approximately 70% of these patients develop phantom limb pain. This type of pain is often described as throbbing, burning, or lacerating pain, or a feeling of pins and needles. Also called stump pain, phantom limb sensations are nonpainful feelings perceived in the absent limb.

What is phantom limb pain feel like?

The pain associated with phantom limb pain is an aching sensation. This is a chronic burning, tingling, and electric-shock pain. The patient describes the burning sensations in the toes, although the leg is not there. Most patients describe this pain as worse with temperature changes, stump irritation, stress, and mild touch. The phantom sensations are more common during the first few months following surgery.

What causes phantom limb pain?

The cause of phantom limb pain is multifactorial, and it has physical and psychological components. The proposed mechanisms of phantom limb pain include peripheral nerve hyperexcitability, cortical reorganization, central sensitization, and visual-proprioceptive dissociation. When certain nerves within the stump are stimulated, the pain is felt in the phantom limb. Many experts theorize that the brain holds the memory of pain experienced before the amputation, and the pain signals continue to transmit even after surgical amputation.

How is phantom limb pain treated?

The pain medicine specialist will use multiple treatment options for phantom limb pain. These include:


Medications – Current therapy involves anticonvulsants, antidepressants, and opioids. Anesthetics are also used, such as topical compounded agents and injectables. As with other painful conditions, finding the right medications may take time and patience. Successful phantom pain relief usually requires a combination of medications.


Mirror therapy – For many patients, the use of mirrors in treatment will help show the brain there is a healthy limb present. Both limbs are placed in a mirror box, which makes the amputated one appear to be intact. The patient is then asked to do exercises with both limbs, which tricks the brain and reduces pain.


Stump stimulation – Using a transcutaneous electrical nerve stimulator (TENS) unit, this interrupts painful sensations. This can also be accomplished using hot or cold packs, pain patches, or by rubbing the stump.


Cognitive therapies – This involves such treatments as relaxation, hypnosis, cognitive behavior therapy (CBT), and guided imagery. These approaches change the way the brain interprets phantom pain sensations.


Acupuncture – This procedure involves sessions 1-2 times each week for several weeks. The practitioner inserts fine needles into the skin and subcutaneous tissue to stimulate endorphin production and restore normal energy flow. A recent clinical study showed that this therapy offered significant pain relief for patients who have had amputations.


Botox injections – Botulinum toxin A is a paralyzing agent used to relief stump tissue pain. In a recent study, researchers found that this to be an effective treatment for stump-related pain as well as phantom limb pain.


Stellate ganglion block – This procedure involves an injection in the front of the neck onto a small bundle of nerves that transport sympathetic nerve signals from the arms. This doctor instills a numbing medication for pain signal blocking. Clinical studies have shown a success rate of 70-80% for this block.


Lumbar sympathetic block – With this procedure, the doctor inserts needles along the outside of the spine using x-ray guidance. Once in place, a long-acting anesthetic is instilled onto the lower back lumbar sympathetic nerves. Occasionally, clonidine, epinephrine, or a corticosteroid medication is added to prolong the lumbar sympathetic block effects.