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Phantom Limb Pain

Phantom Limb Pain Pain Management in Knoxville, TN

According to a 2018 review published by the American Society for Clinical Investigation, around 2 million amputees are currently living in the US and this number is expected to increase. Even though almost all of them sometimes experience sensations that seem to come from the missing limb, for some these sensations can be painful. In this article, we will discuss the mechanisms behind this phenomenon and explore the treatment options for phantom limb pain in Knoxville that are currently available.

What is phantom limb pain?

When a person loses an arm or a leg as a result of an accident or a disease, they can sometimes feel pain in the limb that is not there anymore. Even though the limb is gone, the pain is very real and can be intense and debilitating. Many amputees experience phantom limb pain shortly after amputation, even though it can develop up to a year after the procedure. The pain is usually intermittent, lasting from seconds to hours, but in some cases might be permanent. It can persist for months or even years but typically decreases in frequency and severity over time.

What causes phantom limb pain?

Despite extensive research, the exact cause of phantom limb pain is not very well understood but there are a few theories of the mechanisms behind it:
  • After amputation, the brain loses the input from the missing limb. The readjustment of the stimuli processing might create some irregularities which the brain interprets as pain.
  • The severed nerve endings are characterized by increased excitability and spontaneous discharges, which are thought to be responsible for the pain in the stump as well as phantom limb pain sensation.
  • Studies have shown that after amputation, the area of the brain responsible for the missing limb gets “assigned” to another body part. In that case, when the newly assigned body part is touched, it may cause some confusion in the signaling pathways which may also be interpreted by the brain as pain in the missing limb.
  • It has been proposed that after amputation some changes occur in the part of the spinal cord that the severed nerves originated from. These changes result in the dysregulation of pain receptors leading to phantom limb pain.
Although there is currently no clear consensus on the cause, it is assumed that there are various factors at play and both the central (brain and spinal cord) and the peripheral (nerves) nervous systems are involved.

How common is phantom limb pain?

According to the 2021 review published in the Pain Reports journal, up to 80% of patients experience phantom limb pain after amputation. Around 60% of them report moderate to severe pain levels. Another study found that the pain occurs more frequently in the arms than in the legs.

Signs and symptoms

Phantom limb pain is perceived as coming from the part of the body that is no longer there. It is usually described by the patients in terms typically associated with nerve damage pain, such as tingling, throbbing, burning, or stabbing, but sometimes it resembles the feeling of squeezing or crushing. It is often felt in the fingers or toes of the missing limb. In some patients, certain triggers (for example, cold weather, physical touch, or smoking) can bring on an episode of phantom limb pain. People who had pain in the limb before amputation have a higher risk of experiencing phantom limb pain. Some doctors recommend the use of anesthesia for hours or even days before the procedure to prevent the onset of phantom limb pain later on. Many patients with persistent pain in the remaining part of the limb (often caused by an abnormal growth on the severed nerve endings) tend to also feel it in the missing part.


There is no specific test to diagnose phantom limb pain. Diagnosis is usually based on the symptom description. The doctor will conduct a physical exam and, if necessary, order blood tests or an ultrasound to rule out other possible causes.

How is phantom limb pain treated?

Phantom limb pain can be a challenging disorder to treat. There are various treatment options aimed to relieve the symptoms that may work for some patients but not others. Sometimes it might be necessary to try different combinations of the available treatments in order to find the most effective option:
  • Medications that are used for treating phantom limb pain include over-the-counter painkillers, opioids, antidepressants, and anticonvulsants.
  • Transcutaneous nerve stimulation (TENS) is a non-invasive method of pain relief that sends mild electrical impulses to the affected area of the body.
  • Mirror therapy is a fascinating treatment for phantom limb pain. It uses a mirror reflection of the intact limb to trick the brain into thinking that the missing limb is back. Viewing the movements of the healthy limb and its reflection can help reduce the pain sensation. A novel variation of this method uses virtual reality to achieve the same effect.
  • Anesthetic injections can provide longer-term pain relief and reduce the need for oral medication.
  • Wearing well-fitted prosthetics has also been shown to reduce phantom limb pain.
  • Acupuncture, biofeedback, and relaxation techniques are occasionally used for the treatment of phantom limb pain but evidence of their efficacy is lacking.
In rare cases, surgery (nerve removal) or deep brain stimulation (inserting electrodes into the brain to send electrical impulses) might be performed to help relieve severe pain that does not respond to other types of treatment.


Phantom limb pain is a curious phenomenon that can be frustrating and debilitating for patients. Despite decades of research, the exact causes of the condition are still not fully understood, which makes treatment difficult. There is, however, a variety of options that might be able to provide full or partial relief from phantom limb pain. If you think you might be suffering from this disorder, contacting a doctor will help confirm the diagnosis and develop a personal pain management plan using the treatment methods combination that works for you.

Phantom limb pain treatment in Knoxville, TN

If you’re experiencing chronic pain, it’s time to seek the help of a qualified, caring doctor. Treatment for phantom limb in Knoxville Omega Pain Management often begins with medications and then additional beneficial therapies may be added according to your personal pain management plan. Make an appointment with Dr. Igor Smelyansky offering comprehensive solutions for pain management KnoxvillePhone (865) 337-5137.


Collins KL, Russell HG, Schumacher PJ, Robinson-Freeman KE, O’Conor EC, Gibney KD, Yambem O, Dykes RW, Waters RS, Tsao JW. A review of current theories and treatments for phantom limb pain. J Clin Invest. 2018 Jun 1;128(6):2168-2176. doi: 10.1172/JCI94003. Epub 2018 Jun 1. PMID: 29856366; PMCID: PMC5983333.

Erlenwein J, Diers M, Ernst J, Schulz F, Petzke F. Clinical updates on phantom limb pain. Pain Rep. 2021 Jan 15;6(1):e888. doi: 10.1097/PR9.0000000000000888. PMID: 33490849; PMCID: PMC7813551.