There are reports of two peak periods of onset, the first within a month and the second a year after amputation. The phantom pain and sensation may have its onset immediately or years after the amputation. Phantom sensations and pain have been reported following amputation of different body parts including the eyes, teeth, tongue, nose, breast, penis, bowel, and bladder but the most common occurrence is following limb amputation. Larger population studies are needed for more definite establishment of the risks associated due to the site of involved limb or gender of the patient in development of PLP. A survey reported greater overall average pain intensity and interference in females than males and females endorsed significantly greater catastrophizing, use of certain pain-coping strategies, and beliefs related to several aspects of pain resulting in poor adjustment. It was also reported to be more common among females than males. Recent studies report the prevalence of PLP to be more common among upper limb amputees than lower limb amputees. Risk factor for PLP are shown in Table 1. Superadded phantom sensations are touch and pressure-like sensations felt on the phantom limb from objects such as clothing. Stump pain is described as the pain in the residual portion of the amputated limb whereas phantom sensations are the nonpainful sensations experienced in the body part that no longer exists.

The incidence of PLP has been reported to range from 42.2 to 78.8% in patients requiring amputation. The number of traumatic amputations has also increased since the beginning of conflict in Iraq and Afghanistan. Vascular problems, trauma, cancer, and congenital limb deficiency are among the common causes of limb loss. A recent study estimated that there were about 1.6 million people with limb loss in the USA in 2005 and this number was projected to increase by more than double to 3.6 million by the year 2050. It continues to remain a poorly understood and difficult to treat medical condition. Silas Weir Mitchell, a famous Civil War surgeon in the nineteenth century, coined the term “phantom limb pain” and provided a comprehensive description of this condition. The concept of phantom limb pain (PLP) as being the pain perceived by the region of the body no longer present was first described by Ambrose Pare, a sixteenth century French military surgeon. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain. Most successful treatment outcomes include multidisciplinary measures. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes.

A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain.

Amputee phantom pain management