Course Description:

Phantom limb pain is the continued perception of pain from an amputated limb. It is distinguished from phantom limb sensation, which is the continued sensory perception of a missing limb that is not painful in nature. Phantom limb pain is not the same as stump pain, which is pain that arises from the residual part of the body following an amputation. Phantom limb pain is a type of neuropathic pain. It is common in the first weeks after amputation, then usually decreases, but it can persist for years with a negative impact on functional ability and quality of life. Patients report various painful sensations, such as profound burning, cramping, and squeezing, distal to the level of the amputation. The etiology of phantom limb pain is not fully understood. It is thought that the trauma to the peripheral nerves during amputation sets off cellular alterations as well as structural alterations in the peripheral and central nervous systems, such as hypersensitivity of nociceptors, spontaneous sprouting of afferent neurons, and/or maladaptive reorganization in the cortex. Many different treatments have been used to try to manage phantom limb pain, but with limited success. To be more successful, the underlying mechanisms, which may vary from patient to patient, need to be clarified. Some success has been reported with mirror visual feedback, phantom limb exercises, and motor imagery, but there is a general lack of evidence to support many treatment options.