After your amputation, it is absolutely normal to feel that the limb you have lost is still there, even people born without a limb will feel this Phantom Limb Sensation. If the sensations in your phantom limb are unpleasant, we call it Phantom Limb Pain. We know that pain before and after surgery increase the risk of Phantom Limb Pain, so these are really important times to work with your team to manage that pain.

What causes phantom limb pain?

Phantom limb pain can be unpredictable. You may feel it as soon as the anaesthetic wears off, though it may take time (even weeks) to appear. Sensations may change and often fade in time, or they may continue for years, even a lifetime. 

Everyone’s experience of their phantom limb is unique to them, though there are some common experiences. Your phantom limb may feel stuck in a fixed position or it may move independently. Its movement may be appropriate (eg: reaching out for something) or quite random. Your limb may feel bigger or smaller, it may be in a natural position. It’s often in a similar position to when you last saw it, or it may be doing something weird like going through the bed or stuck in an anatomically impossible position. Typical Phantom Limb Pains include pins and needles, cramp, stabbing or burning sensations.

No-one really understands exactly what causes Phantom Limb Pain. It has been suggested it may be caused by changes in the residual limb or in the central nervous system. However, this doesn’t really explain why the sensations seem to come from the space occupied by the missing limb or why some people born without a limb experience it.
The answer probably lies in the brain where all of our experience is constructed. 

Mirror Therapy

An American neurologist called Ramachandran noticed that changes in body maps that exist within the brain are associated with Phantom Limb Pain. He suggested that Phantom Limb Pain is the brain’s response to being “starved” of feedback from the missing limb. And that if this were true, then tricking the brain into thinking that the limb still exists and is moving might be helpful. He was right. He created Mirror Therapy which we still use today. In fact, many forms of giving the brain this feedback, such as wearing a prosthetic limb, if possible, guided imagery or virtual reality are found to helpful by many people with amputations.

We don’t really know why the brain behaves like this, but we do know our brains are always looking for threats to our safety and Phantom Limb Pain may simply be an anxious brain trying to get us to move a limb it thinks has been static for too long.

Using Mirror Therapy

As much as possible the limb reflected in the mirror needs to align with where the phantom limb is felt to be. This isn’t possible if the phantom limb is in a bizarre position.
It can be a very emotional experience to apparently see the missing limb again. Some people say it is as if the limb is “plugged back in”.

Guided Imagery

Guided Imagery uses the “mind’s eye” to achieve the same illusion. You can do this by relaxing deeply (which in itself is known to be helpful in reducing all kinds of pain) and imagining all the sensations of the limb moving, in as much detail as you can. You can also imagine soothing pain by anything you feel might help, such as imagining a burning sensation being soothed by cool waves of water. It has been theorised that our internal mirror neurons create this helpful effect. It is a skill you can use anywhere.  

Virtual Reality

Universities are exploring how a mixture of Guided Imagery and VR may be even more effective in addressing Phantom Limb Pain.