What is phantom pain? What to know

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Phantom pain is a feeling of pain in a body part that is no longer present, such as an amputated limb. The pain can range from occasional or mild to constant or severe. For most people, phantom pain occurs shortly after the removal of a body part and becomes less severe over time.

Phantom pain is different from residual pain. While phantom pain appears in a body part that is no longer present, residual pain occurs in a body part that is still present near the site of the removal.

For example, a person who undergoes amputation of their lower arm might feel residual pain in the elbow joint. In contrast, phantom pain feels as though there is an injury to the part of the body that no longer exists.

These types of pain are also distinct from phantom sensation, which causes a person to feel as though a removed body part is still present, but without any pain. This can be potentially confusing or even dangerous, as a person may momentarily forget the body part is not there and try to use it.

However, a phantom sensation can also be helpful after an amputation, as it may improve balance.

Phantom pain usually resembles nerve pain. Nerve pain causes sensations such as:

• pins and needles
• electric shock sensations
• shooting or stabbing sensations
• burning

The pain is often most intense in areas farthest away from the center of the body. For example, phantom pain following an arm amputation may feel like pain in the fingers.

Some examples of phantom pain include:

• phantom limb pain, which occurs in people with amputated limbs
• phantom organ pain, which occurs in organs that a surgeon has removed, such as the gallbladder
• other phantom pain, which could include pain in any other body parts that are no longer present, such as the teeth or fingers

Doctors do not fully understand what causes phantom pain. Most research suggests it is a type of nerve pain that occurs because the nerves send false pain signals.

Some potential explanations include:

• Central sensitization: This is a process that changes the body’s pain perception, making a person more sensitive to pain. It often occurs in people with chronic pain.
• Nerve damage: Amputation or organ removal may damage nerves that provide the brain with information about the missing body part. This can cause them to continue to send pain signals even when a body part is gone.
• Disease processes: The disease that led to the body part removal may also damage nerves, causing them to generate phantom pain even after a body part is gone. For example, diabetes may damage nerves in the feet and legs.
• Brain changes: Following the removal of a body part, the brain must change how it organizes information about the body. As the brain performs this process, a person may feel phantom pain.

It is important to note that mental health conditions, such as depression, do not increase the risk of phantom limb pain. However, these conditions may affect the symptoms and their severity if a person does develop phantom pain.

Treating phantom limb pain can be difficult. There is no standard treatment that works for everyone, and treatments that do help may not relieve the pain entirely. A person experiencing phantom pain may need to work with a pain specialist and try several different interventions.

Some treatments that may help include:

• Nerve stimulation: Nerve stimulation devices deliver electrical signals to nerves that may ease phantom pain. For example, transcutaneous electrical nerve stimulation (TENS) and peripheral nerve stimulation devices may offer relief to some people.
• Pain medication: Pain medications such as nonsteroidal inflammatory drugs may help some people. In certain cases, doctors may prescribe opioids, but these drugs carry a risk of dependency.
• Antidepressants: Antidepressants may help with some forms of central sensitization. They may also help counter the mental health effects of living with pain.
• Other drugs: A wide range of other medications may help. For example, topical creams may help some people, and beta-blockers have shown promise in some studies but not others.
• Prosthetic usage: Multiple studies have shown that using prosthetic limbs reduces phantom pain. Additionally, prostheses with feedback technology improve limb mobility and movement perception.
• Mirror therapy: This involves performing exercises while looking in a mirror at an intact limb or body part. For example, a person with an arm amputation might look at the mirror image of the opposite arm. The idea is that this shows the brain both limbs are intact and healthy, reducing pain.
• Virtual reality (VR): Virtual or augmented reality is similar to mirror therapy but involves using a computer simulation to create the impression that a body part is still present. There are few studies on the effectiveness of this therapy.
• Alternative therapies: Biofeedback, acupuncture, and other interventions may provide pain relief.
• Surgery: Some people find relief from additional surgery. Doctors usually only recommend this if other interventions do not work.

Phantom pain is usually worse in the weeks and months immediately following the removal of a body part. In many people, it either goes away on its own or improves with time.

This is not the case for everyone. A 2021 study reports on prior research suggesting that about 10% of people who have amputations continue to have severe pain 6 months or longer after surgery.

However, with treatment, most people find that the pain diminishes or even goes away entirely.

Phantom pain is a challenging condition that scientists are still trying to understand. However, for many people, phantom limb pain gets better with time.

It is important for a doctor to assess whether something else could be causing the pain, such as an infection or injury in the remaining structures, before making a diagnosis.

If it is phantom pain, a doctor who specializes in this can help develop a custom treatment strategy. This may involve nerve stimulation, medications, mirror therapy, or newer approaches, such as VR.