phantom limb


Summary: Perception of painful and nonpainful phantom sensations that occur following the complete or partial loss of a limb. The majority of individuals with an amputated extremity will experience the impression that the limb is still present, and in many cases, painful. (From Neurol Clin 1998 Nov;16(4):919-36; Brain 1998 Sep;121(Pt 9):1603-30)

Top Publications

  1. Wu H, Sultana R, Taylor K, Szabo A. A prospective randomized double-blinded pilot study to examine the effect of botulinum toxin type A injection versus Lidocaine/Depomedrol injection on residual and phantom limb pain: initial report. Clin J Pain. 2012;28:108-12 pubmed publisher
    Botulinum toxin type A (Botox) injection has been used to manage pain. However, it remains to be proved whether Botox injection is effective to relieve residual limb pain (RLP) and phantom limb pain (PLP).
  2. Katayama Y, Yamamoto T, Kobayashi K, Kasai M, Oshima H, Fukaya C. Motor cortex stimulation for phantom limb pain: comprehensive therapy with spinal cord and thalamic stimulation. Stereotact Funct Neurosurg. 2001;77:159-62 pubmed
    ..thalamic nucleus ventralis caudalis (VC) and motor cortex stimulation (MCS) were analyzed in 19 patients with phantom limb pain...
  3. Foell J, Bekrater Bodmann R, Flor H, Cole J. Phantom limb pain after lower limb trauma: origins and treatments. Int J Low Extrem Wounds. 2011;10:224-35 pubmed publisher
    ..presence of the limb, with some describing additional sensations such as numbness, tickling, or cramping of the phantom limb. The type, frequency, and stability of these phantom sensations can vary immensely...
  4. Moseley G, Gallace A, Spence C. Is mirror therapy all it is cracked up to be? Current evidence and future directions. Pain. 2008;138:7-10 pubmed publisher
  5. Diers M, Christmann C, Koeppe C, Ruf M, Flor H. Mirrored, imagined and executed movements differentially activate sensorimotor cortex in amputees with and without phantom limb pain. Pain. 2010;149:296-304 pubmed publisher
    ..the neural correlates of mirrored, imagined and executed hand movements in 14 upper extremity amputees - 7 with phantom limb pain (PLP) and 7 without phantom limb pain (non-PLP) and 9 healthy controls (HC)...
  6. de Roos C, Veenstra A, de Jongh A, den Hollander Gijsman M, van der Wee N, Zitman F, et al. Treatment of chronic phantom limb pain using a trauma-focused psychological approach. Pain Res Manag. 2010;15:65-71 pubmed
    Chronic phantom limb pain (PLP) is a disabling chronic pain syndrome for which regular pain treatment is seldom effective...
  7. Acerra N, Souvlis T, Moseley G. Stroke, complex regional pain syndrome and phantom limb pain: can commonalities direct future management?. J Rehabil Med. 2007;39:109-14 pubmed
    Despite being different conditions, complex regional pain syndrome type 1, phantom limb pain and stroke share some potentially important similarities. This report examines experimental and clinical findings from each patient population...
  8. Kawashima N, Mita T. Metal bar prevents phantom limb motion: case study of an amputation patient who showed a profound change in the awareness of his phantom limb. Neurocase. 2009;15:478-84 pubmed publisher
    ..S., a 60-year-old male forelimb amputee) who had an extraordinary experience with a phantom limb. He complained that he could not move the wrist of his phantom limb because a metal bar was perceived to be ..
  9. Huang C, Yang R, Kuo T, Hsu K. Phantom limb pain treated by far infrared ray. Conf Proc IEEE Eng Med Biol Soc. 2009;2009:1589-91 pubmed publisher
    We have treated a patient with severe phantom limb pain by a novel far infrared ray (FIR) therapy. The patient has suffered persistent and progressively worsening phantom limb pain after amputation ten years ago...

More Information


  1. Flor H. Maladaptive plasticity, memory for pain and phantom limb pain: review and suggestions for new therapies. Expert Rev Neurother. 2008;8:809-18 pubmed publisher
    A number of studies have shown that phantom limb pain is associated with plastic changes along the neuraxis, with a close correlation between changes in the cortical representation of the affected limb and phantom limb pain...
  2. Richardson C, Glenn S, Nurmikko T, Horgan M. Incidence of phantom phenomena including phantom limb pain 6 months after major lower limb amputation in patients with peripheral vascular disease. Clin J Pain. 2006;22:353-8 pubmed
    Contentions exist regarding the true incidence of phantom limb pain (PLP) and other associated post-amputation phenomena. Recognizing and understanding these phenomena would assist in the rehabilitation of amputees...
  3. Oakley D, Whitman L, Halligan P. Hypnotic imagery as a treatment for phantom limb pain: two case reports and a review. Clin Rehabil. 2002;16:368-77 pubmed
    To provide a theoretical background, to review existing literature and to present new case material relevant to the treatment of phantom limb pain using hypnotic imagery.
  4. Casale R, Ceccherelli F, Labeeb A, Biella G. Phantom limb pain relief by contralateral myofascial injection with local anaesthetic in a placebo-controlled study: preliminary results. J Rehabil Med. 2009;41:418-22 pubmed publisher
    To ascertain the existence of contralateral painful muscle areas mirroring phantom pain and to evaluate the short-term effects of anaesthetic vs saline, injected contra notlaterally to control phantom and phantom limb pain.
  5. Hirsh A, Dillworth T, Ehde D, Jensen M. Sex differences in pain and psychological functioning in persons with limb loss. J Pain. 2010;11:79-86 pubmed publisher
    ..Participants provided ratings of phantom limb pain (PLP), residual limb pain (RLP), and general pain intensity...
  6. Karl A, Diers M, Flor H. P300-amplitudes in upper limb amputees with and without phantom limb pain in a visual oddball paradigm. Pain. 2004;110:40-8 pubmed
    ..Five amputees with phantom limb pain (PLP), five amputees without PLP (Non-PLP) and 10 healthy controls (HC) were investigated using a visual ..
  7. Tognù A, Borghi B, Gullotta S, White P. Ultrasound-guided posterior approach to brachial plexus for the treatment of upper phantom limb syndrome. Minerva Anestesiol. 2012;78:105-8 pubmed
    ..the clinical value of the ultrasound-guided posterior approach to the brachial plexus in the treatment of phantom limb syndrome after an upper extremity amputation...
  8. Price E. A critical review of congenital phantom limb cases and a developmental theory for the basis of body image. Conscious Cogn. 2006;15:310-22 pubmed
    ..This model unites several previously disparate theories to offer a viable solution to several longstanding phantom limb mysteries and serves to highlight avenues worthy of further inquiry.
  9. Kern U, Busch V, Rockland M, Kohl M, Birklein F. [Prevalence and risk factors of phantom limb pain and phantom limb sensations in Germany. A nationwide field survey]. Schmerz. 2009;23:479-88 pubmed publisher
    Data on the incidence and intensity of phantom limb pain (PLP) and phantom limb sensations (PLS) were collected in a nationwide survey.
  10. Preissler S, Feiler J, Dietrich C, Hofmann G, Miltner W, Weiss T. Gray matter changes following limb amputation with high and low intensities of phantom limb pain. Cereb Cortex. 2013;23:1038-48 pubmed publisher
    Limb amputation and chronic phantom limb pain (PLP) are both associated with neural alterations at all levels of the neuraxis. We investigated gray matter volume of 21 upper limb amputees and 14 healthy control subjects...
  11. Ray N, Jenkinson N, Kringelbach M, Hansen P, Pereira E, Brittain J, et al. Abnormal thalamocortical dynamics may be altered by deep brain stimulation: using magnetoencephalography to study phantom limb pain. J Clin Neurosci. 2009;16:32-6 pubmed publisher
    ..We were able to record activity over the occipital lobe of a patient using DBS for phantom limb pain during presentation of a visual stimulus...
  12. Topper R, Foltys H, Meister I, Sparing R, Boroojerdi B. Repetitive transcranial magnetic stimulation of the parietal cortex transiently ameliorates phantom limb pain-like syndrome. Clin Neurophysiol. 2003;114:1521-30 pubmed
    ..Phantom pain is linked to a reorganization of the partially deafferented sensory cortex. In this study we have investigated whether the pain syndrome can be influenced by repetitive transcranial magnetic stimulation (rTMS)...
  13. Desmond D, MacLachlan M. Prevalence and characteristics of phantom limb pain and residual limb pain in the long term after upper limb amputation. Int J Rehabil Res. 2010;33:279-82 pubmed publisher
    This study aims to describe the prevalence and characteristics of phantom limb pain and residual limb pain after upper limb amputation. One-hundred and forty-one participants (139 males; mean age 74.8 years; mean time since amputation 50...
  14. Spiegel D, Lappinen E, Gottlieb M. A presumed case of phantom limb pain treated successfully with duloxetine and pregabalin. Gen Hosp Psychiatry. 2010;32:228.e5-7 pubmed publisher
    b>Phantom limb pain (PLP) may occur in nearly 80% of amputation patients. Current research has highlighted several changes that occur in the nociception pathway post amputation...
  15. Wiech K, Kiefer R, Töpfner S, Preissl H, Braun C, Unertl K, et al. A placebo-controlled randomized crossover trial of the N-methyl-D-aspartic acid receptor antagonist, memantine, in patients with chronic phantom limb pain. Anesth Analg. 2004;98:408-13, table of contents pubmed
    ..of the N-methyl-D-aspartic acid (NMDA) receptor antagonist memantine (30 mg/d) on the intensity of chronic phantom limb pain (PLP) and cortical reorganization...
  16. Beaumont G, Mercier C, Michon P, Malouin F, Jackson P. Decreasing phantom limb pain through observation of action and imagery: a case series. Pain Med. 2011;12:289-99 pubmed publisher
    b>Phantom limb pain is often resistant to treatment. Techniques based on visual-kinesthetic feedback could help reduce it.
  17. Smith D, Ehde D, Hanley M, Campbell K, Jensen M, Hoffman A, et al. Efficacy of gabapentin in treating chronic phantom limb and residual limb pain. J Rehabil Res Dev. 2005;42:645-54 pubmed
    Twenty-four adults with phantom limb pain (PLP) and/or residual limb pain (RLP) participated in a double-blind crossover trial...
  18. MacLachlan M, McDonald D, Waloch J. Mirror treatment of lower limb phantom pain: a case study. Disabil Rehabil. 2004;26:901-4 pubmed
    b>Phantom limb pain (PLP) can be an enduring and distressing experience for people with amputations...
  19. Mishra S, Bhatnagar S, Gupta D, Diwedi A. Incidence and management of phantom limb pain according to World Health Organization analgesic ladder in amputees of malignant origin. Am J Hosp Palliat Care. 2007;24:455-62 pubmed
    ..The present study of 42 cancer patients with limb amputation was conducted to determine the incidence of phantom limb pain and phantom sensation and to test the utility of the World Health Organization 3-step analgesic ladder in ..
  20. Viswanathan A, Phan P, Burton A. Use of spinal cord stimulation in the treatment of phantom limb pain: case series and review of the literature. Pain Pract. 2010;10:479-84 pubmed publisher
    Despite technical advances in spinal cord stimulation (SCS), there is a paucity of recent literature regarding SCS for phantom limb pain.
  21. Moseley G. Graded motor imagery for pathologic pain: a randomized controlled trial. Neurology. 2006;67:2129-34 pubmed
    b>Phantom limb and complex regional pain syndrome type 1 (CRPS1) are characterized by changes in cortical processing and organization, perceptual disturbances, and poor response to conventional treatments...
  22. Brodie E, Whyte A, Niven C. Analgesia through the looking-glass? A randomized controlled trial investigating the effect of viewing a 'virtual' limb upon phantom limb pain, sensation and movement. Eur J Pain. 2007;11:428-36 pubmed
    The extent to which viewing a 'virtual' limb, the mirror image of an intact limb, modifies the experience of a phantom limb, was investigated in 80 lower limb amputees before, during and after repeated attempts to simultaneously move both ..
  23. Hall G, Carroll D, McQuay H. Primary care incidence and treatment of four neuropathic pain conditions: a descriptive study, 2002-2005. BMC Fam Pract. 2008;9:26 pubmed publisher
    ..The most common first line treatments were compound analgesics. As therapeutic options have subsequently changed, this study presents updated data on incidence and prescribing patterns in neuropathic pain...
  24. Reilly K, Mercier C, Schieber M, Sirigu A. Persistent hand motor commands in the amputees' brain. Brain. 2006;129:2211-23 pubmed
    ..We recorded stump muscle activity when above-elbow amputees voluntarily moved their phantom limb. Voluntary movements of the phantom hand triggered specific patterns of stump muscle activity, which differed ..
  25. Murray C, Patchick E, Pettifer S, Caillette F, Howard T. Immersive virtual reality as a rehabilitative technology for phantom limb experience: a protocol. Cyberpsychol Behav. 2006;9:167-70 pubmed
    ..describes a study protocol to investigate the use of immersive virtual reality as a treatment for amputees' phantom limb pain...
  26. Mercier C, Sirigu A. Training with virtual visual feedback to alleviate phantom limb pain. Neurorehabil Neural Repair. 2009;23:587-94 pubmed publisher
    Performing phantom movements with visual virtual feedback, or mirror therapy, is a promising treatment avenue to alleviate phantom limb pain. However the effectiveness of this approach appears to vary from one patient to another.
  27. Schmidt A, Takahashi M, de Paula Posso I. Phantom limb pain induced by spinal anesthesia. Clinics (Sao Paulo). 2005;60:263-4 pubmed
  28. Pereira J, Alves R. The labelled-lines principle of the somatosensory physiology might explain the phantom limb phenomenon. Med Hypotheses. 2011;77:853-6 pubmed publisher
    ..We believe these factors, involved in the pathophysiology of phantom limb (PHL), might be the explanation for this intriguing phenomenon.
  29. Karanikolas M, Aretha D, Tsolakis I, Monantera G, Kiekkas P, Papadoulas S, et al. Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency: a prospective, randomized, clinical trial. Anesthesiology. 2011;114:1144-54 pubmed publisher
    Severe preamputation pain is associated with phantom limb pain (PLP) development in limb amputees. We investigated whether optimized perioperative analgesia reduces PLP at 6-month follow-up.
  30. Flor H, Diers M, Andoh J. The neural basis of phantom limb pain. Trends Cogn Sci. 2013;17:307-8 pubmed publisher
    ..These findings add valuable information on cortical reorganization after amputation. We suggest further lines of research to clarify the mechanisms that underlie phantom pain. ..
  31. Maciver K, Lloyd D, Kelly S, Roberts N, Nurmikko T. Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery. Brain. 2008;131:2181-91 pubmed publisher
    Using functional MRI (fMRI) we investigated 13 upper limb amputees with phantom limb pain (PLP) during hand and lip movement, before and after intensive 6-week training in mental imagery...
  32. Flor H. Phantom-limb pain: characteristics, causes, and treatment. Lancet Neurol. 2002;1:182-9 pubmed
    ..The prevention of phantom-limb pain by peripheral analgesia has not yielded consistent results. Additional measures that reverse or prevent the formation of central memory processes might be more effective...
  33. Roux F, Lotterie J, Cassol E, Lazorthes Y, Sol J, Berry I. Cortical areas involved in virtual movement of phantom limbs: comparison with normal subjects. Neurosurgery. 2003;53:1342-52; discussion 1352-3 pubmed
  34. Jin L, Kollewe K, Krampfl K, Dengler R, Mohammadi B. Treatment of phantom limb pain with botulinum toxin type A. Pain Med. 2009;10:300-3 pubmed publisher
    b>Phantom limb pain and sensations are common in amputees. The pathophysiology remains unclear and the treatment difficult and often unsuccessful...
  35. Antoniello D, Kluger B, Sahlein D, Heilman K. Phantom limb after stroke: an underreported phenomenon. Cortex. 2010;46:1114-22 pubmed publisher
    The presence of a phantom limb (PL) resulting from a cerebral lesion has been reported to be a rare event. No prior study, however, has systematically investigated the prevalence of this syndrome in a group of post-stroke individuals...
  36. Hackworth R, Tokarz K, Fowler I, Wallace S, Stedje Larsen E. Profound pain reduction after induction of memantine treatment in two patients with severe phantom limb pain. Anesth Analg. 2008;107:1377-9 pubmed publisher
    We present the cases of two patients who suffered severe lower extremity injuries and subsequently developed phantom limb pain (PLP) that was refractory to high dose opioids and adjunctive pain medications...
  37. Hu Y, Li Y, Zhang X, Zhang Y, Ma K, Yu T. [A study on neurosurgical treatment for phantom limb pain]. Zhonghua Wai Ke Za Zhi. 2007;45:1668-71 pubmed
    To study the clinical effect of combination of mesencephalotomy with bilateral anterior cingulotomy, and destroy spinal cord dorsal root entry zone (DREZ) treatment for phantom limb pain (PLP).
  38. Murray C, Pettifer S, Howard T, Patchick E, Caillette F, Kulkarni J, et al. The treatment of phantom limb pain using immersive virtual reality: three case studies. Disabil Rehabil. 2007;29:1465-9 pubmed
    This paper describes the design and implementation of a case study based investigation using immersive virtual reality as a treatment for phantom limb pain.
  39. Weeks S, Anderson Barnes V, Tsao J. Phantom limb pain: theories and therapies. Neurologist. 2010;16:277-86 pubmed publisher
    ..b>Phantom limb pain (PLP) frequently develops in these individuals...
  40. Mercier C, Reilly K, Vargas C, Aballea A, Sirigu A. Mapping phantom movement representations in the motor cortex of amputees. Brain. 2006;129:2202-10 pubmed
    ..the corresponding perceptual representation does not suffer a similar fate but instead persists as a phantom limb endowed with sensory and motor qualities...
  41. Bolognini N, Olgiati E, Maravita A, Ferraro F, Fregni F. Motor and parietal cortex stimulation for phantom limb pain and sensations. Pain. 2013;154:1274-80 pubmed publisher
    Limb amputation may lead to chronic painful sensations referred to the absent limb, ie phantom limb pain (PLP), which is likely subtended by maladaptive plasticity...
  42. Thomas C, Brazeal B, Rosenberg L, Robert R, Blakeney P, Meyer W. Phantom limb pain in pediatric burn survivors. Burns. 2003;29:139-42 pubmed
    b>Phantom limb sensation and pain are reported by youth following amputations...
  43. Haigh R, McCabe C, Halligan P, Blake D. Joint stiffness in a phantom limb: evidence of central nervous system involvement in rheumatoid arthritis. Rheumatology (Oxford). 2003;42:888-92 pubmed
    ..To test this hypothesis, patients with a phantom limb (PL) who had experienced characteristic RA stiffness prior to amputation were systematically investigated.
  44. Wolff A, Vanduynhoven E, van Kleef M, Huygen F, Pope J, Mekhail N. 21. Phantom pain. Pain Pract. 2011;11:403-13 pubmed publisher
    ..The reported incidence of phantom limb pain after trauma, injury or peripheral vascular diseases is 60% to 80%...
  45. Harden R, Houle T, Green S, Remble T, Weinland S, Colio S, et al. Biofeedback in the treatment of phantom limb pain: a time-series analysis. Appl Psychophysiol Biofeedback. 2005;30:83-93 pubmed
    b>Phantom limb pain (PLP) is a noxious, painful sensation that is perceived to occur in an amputated limb. It has been reported to occur in up to 85% of amputees...
  46. Reilly K, Sirigu A. The motor cortex and its role in phantom limb phenomena. Neuroscientist. 2008;14:195-202 pubmed reconcile with evidence that a perceptual representation of the missing limb persists in the form of a phantom limb endowed with sensory and motor qualities...
  47. Bergmans L, Snijdelaar D, Katz J, Crul B. Methadone for phantom limb pain. Clin J Pain. 2002;18:203-5 pubmed
    The objective of this case series was to determine if severe phantom limb pain could be reduced with oral methadone.
  48. Byrne K. Survey of phantom limb pain, phantom sensation and stump pain in Cambodian and New Zealand amputees. Pain Med. 2011;12:794-8 pubmed publisher
    The primary objective of this study is to compare the prevalence of phantom limb pain in New Zealand and Cambodian amputees and to assess the demographics of a sample of amputees from these two countries.
  49. Funk M, Shiffrar M, Brugger P. Hand movement observation by individuals born without hands: phantom limb experience constrains visual limb perception. Exp Brain Res. 2005;164:341-6 pubmed
    ..Additional research with aplasic individuals, having and lacking phantom sensations, is needed to resolve this issue...
  50. Nava E, Röder B. Adaptation and maladaptation insights from brain plasticity. Prog Brain Res. 2011;191:177-94 pubmed publisher
    ..Here, we will consider brain plasticity and its functional and structural consequences from an evolutionary perspective, discussing cases of adaptive and maladaptive plasticity and using examples from typical and atypical development...
  51. Giraux P, Sirigu A. Illusory movements of the paralyzed limb restore motor cortex activity. Neuroimage. 2003;20 Suppl 1:S107-11 pubmed
    ..R. Soc. London B Biol. Sci. 263, 377-386). The neural basis of phantom limb sensation and its amelioration remains unclear...
  52. Schneider J, Hofmann A, Rost C, Shapiro F. EMDR in the treatment of chronic phantom limb pain. Pain Med. 2008;9:76-82 pubmed publisher
    Little research substantiates long-term gains in the treatment of phantom limb pain. This report describes and evaluates an eye movement desensitization and reprocessing (EMDR) treatment with extensive follow-up.
  53. Su C, Liu K, Wang Y. Midazolam as an effective drug for severe phantom limb pain in a patient after undergoing spinal anesthesia for two consecutive surgeries in the contralateral lower limb. Acta Anaesthesiol Taiwan. 2009;47:32-5 pubmed publisher
    Recurrence or exacerbation of phantom limb pain induced by regional anesthesia including spinal anesthesia, epidural anesthesia, and peripheral nerve block has been described in a few reports...