Understanding and Managing Phantom Limb Pain

At Horizon Spine & Pain of Utah, we are committed to helping patients who experience phantom limb pain (PLP) — a unique and often misunderstood type of chronic pain that can occur after an amputation. If you are living with pain that feels like it's coming from a part of your body that's no longer there, you are not alone, and effective treatments are available.

Phantom limb pain refers to ongoing sensations of pain, burning, throbbing, or cramping that seem to come from the amputated limb. Unlike "phantom sensations" (which may feel like tingling or movement), PLP is painful and can interfere significantly with daily life and emotional well-being.

The exact cause of PLP is complex, but researchers believe it involves both nerve changes in the stump and reorganization of the brain's sensory map after limb loss. Factors that contribute to PLP may include:

• Damaged nerve endings at the amputation site
• Abnormal nerve signaling
• Changes in the spinal cord and brain response to missing sensory input

Pain may begin within days after surgery or sometimes weeks or months later.

Some individuals are more likely to experience phantom limb pain, including:

• Traumatic amputations (accidents, combat injuries)
• Severe pain in the limb before amputation (pre-amputation pain)
• Poorly fitting prosthetics
• Infection or poor healing at the surgical site
• Emotional stress, anxiety, or depression

Prompt treatment of stump pain and careful surgical planning can reduce the risk of developing PLP.

Phantom limb pain symptoms often include:

• Burning, stabbing, or shooting pain
• Cramping or squeezing sensations
• Tingling or numbness
• Sudden, intense pain episodes
• Pain triggered by weather changes or emotional stress

Symptoms can be mild and occasional or severe and constant, affecting quality of life.

At Horizon Spine & Pain of Utah, diagnosing PLP begins with:

• Detailed medical and surgical history review
• Pain mapping and symptom tracking
• Physical examination of the residual limb (stump)
• Imaging tests (as needed) to rule out complications like infection, bone spurs, or neuromas (nerve tumors)

Correct diagnosis ensures we target the true source of your pain effectively.

We offer a wide range of non-surgical treatments for phantom limb pain, including:

• Medications: Anticonvulsants (gabapentin, pregabalin), antidepressants (amitriptyline, nortriptyline), and pain relievers
• Physical therapy: Stretching, strengthening, and desensitization techniques
• Mirror therapy: Using a mirror to "trick" the brain into seeing the missing limb, often reducing pain
• Behavioral therapy: Managing the emotional and psychological impact of chronic pain

These therapies are tailored to each patient's symptoms and goals.

For persistent or severe phantom limb pain, we offer advanced interventional treatments:

• Nerve blocks: Injections around major nerves to interrupt pain signals
• Spinal cord stimulation (SCS): A minimally invasive technique using mild electrical pulses to reduce nerve pain
• Peripheral nerve stimulation (PNS): Targeted nerve stimulation for localized pain control

These therapies can dramatically improve quality of life without major surgery.

If non-surgical and injection therapies fail, surgery may be considered, such as:

• Targeted muscle reinnervation (TMR): Redirecting severed nerves into healthy muscles to reduce pain
• Revision surgery: Correcting issues at the amputation site like neuromas
• Implantable neurostimulators: For long-term nerve modulation

Surgical options are customized for each patient and recommended only when absolutely necessary.

When it comes to phantom limb pain management, Horizon Spine & Pain of Utah offers:

• Board-certified pain management specialists with expertise in complex nerve pain
• Comprehensive evaluations to identify all factors contributing to your pain
• Advanced, minimally invasive therapies focused on lasting relief
• Collaborative care integrating physical therapy, psychology, and interventional pain management
• Access to patient education resources

We are dedicated to helping every patient reclaim their comfort, function, and independence.