Phantom Limb Pain

What is Phantom Limb Pain?

Phantom limb pain is pain that originates in a limb that has been amputated. It is not psychological, and it is not imagined. The sensation is generated by the nervous system: the peripheral nerve endings at the amputation site develop abnormal electrical activity, and the spinal cord and brain continue to process pain signals from pathways that once served the missing limb.

The condition affects 60 to 80 percent of amputees in the period immediately after surgery, and up to 70 percent continue to experience it years or decades later. The risk is higher in people who had significant pain in the limb before amputation, in traumatic compared to elective amputations, and in upper limb loss. The brain’s representation of the body reorganises after amputation, and this neuroplastic change can perpetuate pain even after the peripheral signals have diminished.

Phantom limb pain is distinct from residual limb pain (stump pain), which originates at the amputation site, and phantom sensation, which is a painless awareness of the missing limb. All three can coexist.

Symptoms

• Burning, stabbing, aching, or electric-shock pain perceived in the absent limb
• Cramping or the feeling that the phantom limb is locked in a painful position
• Pain that fluctuates in intensity, often worse at night or with stress
• Tingling or pressure sensations in the missing limb
• Triggers including touch to the residual limb, temperature changes, or emotional distress
• Telescoping, where the phantom limb seems to shorten toward the stump over time

How We Treat It

We approach phantom limb pain as a central nervous system problem with peripheral contributions. Peripheral nerve blocks at the residual limb can interrupt the abnormal electrical signalling from nerve endings at the stump, providing periods of relief and sometimes resetting the pain cycle for longer periods. These are most effective when the peripheral component is driving a significant part of the pain.

Radiofrequency ablation targets specific nerve pathways involved in transmitting the abnormal signals and can provide sustained relief where blocks have been temporarily effective. We use these procedures alongside non-interventional strategies: mirror therapy creates a visual illusion that retrains the brain’s representation of the limb and has solid evidence behind it. Our goal is to reduce the intensity and frequency of phantom pain using the least invasive combination that works for each patient’s presentation.