What Is Phantom Pain? 7 Things to Know About It

How can you feel a limb that’s no longer there? For decades, doctors dismissed phantom pain as a psychological phenomenon. Now, they know there’s more to the matter than the psyche.

What is phantom pain? Do all amputees experience it? Here are seven things you should know about the experience.

Nearly 2 million people in the U.S. have an amputated limb. Therefore, you’re not alone if you fall into this category. Wars, automobile accidents, and industrial mistakes often claim victims.

In the past, doctors dismissed phantom pain as psychological, believing it to be part of the grief process. However, they now recognize it as physiological.

Your brain connects to every other area of your body through the nerves, which extend off your spinal column in pairs. When you have an amputation, your brain continues to send signals down your spine, even though the limb those impulses are meant to control no longer serve their function.

In short, it takes your brain and body a while to adjust. To put it another way, the “railroad” is still there, but the “train” no longer goes all the way to the “station.”

If you experience this phenomenon, you’re far from alone. Anywhere from 50% to 80% of amputees experience phantom limb pain. What does the sensation feel like?

The quality of the pain may vary. Some patients describe it as a shooting or stabbing pain that comes and goes. Others experience a continuous sensation of cramping, pins and needles, crushing, throbbing, or burning.

Phantom pain may strike as early as a week after amputation, although it’s delayed by several months in some. It most often affects the part of the body farthest from the amputation point. For example, someone who had their leg amputated at the knee may experience sensations in the missing toes or feet.

Like many afflictions, phantom pain occurs on a severity spectrum. If yours is bad enough to interfere with your daily activities or keep you up at night, please speak with your doctor. They may try one of the following approaches:

• Opioids: These drugs used to be the first line of defense against pain. They work by affecting the area of your brain that processes pain sensations. However, many patients now have to jump through hoops to obtain such prescriptions, reporting to clinics as often as weekly for testing, thanks to the opioid epidemic.
• Anticonvulsants: Drugs such as gabapentin (Neurontin) and pregabalin (Lyrica) affect nerve pain.
• Antidepressants: Since antidepressants affect your neurotransmitters, the right one may diminish the sensation of phantom pain.
• N-methyl-d-aspartate receptor antagonists: Drugs like ketamine and dextromethorphan can relieve phantom pain.

Please keep in mind that nearly all prescriptions involve side effects. Please communicate openly with your doctor about your experiences to ensure the adverse effects don’t outweigh the relief you get.

However, not everyone has phantom pain severe enough to warrant coughing up a copay. You may find relief with over-the-counter (OTC) analgesics.

What’s your best bet? In this case, acetaminophen – or paracetamol, for folks across the pond – is probably your best bet. Although doctors aren’t sure how this medication works, they believe it blocks enzymes that create prostaglandins and pain-signaling molecules. By interrupting these impulses, you find relief.

What about aspirin, naproxen, and ibuprofen? These drugs likely won’t help much. They’re classified as NSAIDs – non-steroidal anti-inflammatory drugs. They could help reduce swelling if you hit your toe with a hammer, but they won’t do much to ease pain from a limb that’s no longer there to become inflamed.

Some researchers hypothesize that phantom pain results from poor pain management before surgery. It makes sense. If you have ever injured an area that later aches when it rains, you recognize that it doesn’t take much to turn your body’s agony pathways back on once they become ingrained.

Preemptive analgesia uses a nerve block to deaden the barrage of pain input before surgery. While this knowledge won’t help you much if you’ve already had your amputation, it’s something to discuss with your doctor if you have a procedure scheduled.

The ancient practice of acupuncture may ease phantom pain. Eastern practitioners attribute the benefits to the flow of chi, although western researchers hypothesize that the needles manipulate nerve signals.

If you try this route, ensure your practitioner is licensed in your state. It costs anywhere from $75 to $150 per treatment, although some insurers now offer coverage.

Certain experimental treatments may also ease phantom pain. Ask your doctor about the following:

• Repetitive transcranial magnetic stimulation: In this treatment, you use a device strapped to your forehead to stimulate nerves.
• Spinal cord stimulation: In this therapy, your physician surgically inputs a device that sends low levels of electricity directly to your spinal cord to ease the pain.
• Brain stimulation surgery: This procedure involves implanting electrodes in your brain that generate electrical pulses.

If your missing limb aches, the sensation isn’t all in your head. It’s a matter of how your nervous system responds.

However, that doesn’t stop the pain from compromising your quality of life. Fortunately, you can ease phantom pain by talking to your doctor and finding the right treatment approach.