Phantom limb pain is the experience of painful sensations perceived as arising from a body part that has been amputated or congenitally absent. It affects 60-85% of adults after limb amputation according to multiple cohort studies, with most experiencing onset in the first week after surgery.
Phantom limb pain (ICD-10: G54.6 phantom limb syndrome with pain) is a neuropathic pain syndrome in which patients perceive painful sensations originating from a limb that has been amputated, surgically removed, or congenitally absent. It is one of three related post-amputation pain phenomena, alongside non-painful phantom limb sensation (G54.7) and residual (stump) limb pain, with substantial overlap between them. Pathophysiology involves both peripheral and central mechanisms. Peripheral contributors include neuroma formation at the cut nerve end with spontaneous and ectopic activity, sensitization of dorsal root ganglion neurons, and afferent input from residual limb tissues.
The key symptoms of Phantom Limb Pain are: Painful sensations perceived as arising from the missing limb, present despite the absence of that body part — most often described as cramping, burning, stabbing, electric-shock, crushing, or 'squeezing'., Episodic paroxysms lasting seconds to hours, occurring multiple times daily in 50-60% of patients, with intensity peaks of 7-10 on the Numeric Rating Scale., Constant background phantom pain in 30-40% of patients, often with episodic exacerbations., Specific positional 'phantom' sensations: the phantom hand may feel clenched, the fingernails digging into the palm, or the foot fixed in an awkward position — sometimes mirroring how the pre-amputation limb felt., Triggering by emotional stress, fatigue, weather changes, residual limb stimulation, urination or defecation, or sexual activity (referred phantom sensations)., Telescoping: a sensation that the phantom limb gradually shortens over months, the hand or foot retracting toward the stump., Pain referred to the phantom limb from other body sites — touching the face or chest may elicit sensation in the phantom hand (somatosensory remapping)..
Phantom limb pain is a clinical diagnosis based on the history of amputation and a characteristic post-amputation pain pattern referred to the missing body part. There is no specific imaging or laboratory test. The diagnostic workup focuses on distinguishing phantom limb pain from residual limb pain (common but treatable causes include neuroma, prosthesis fit, heterotopic ossification, infection, ischemia), characterizing severity and impact, identifying modifiable contributing factors, and screening for psychological comorbidities. History captures onset, character, frequency, duration, triggers, position of the phantom, and prior treatments. The Brief Pain Inventory, Numeric Rating Scale, painDETECT (for neuropathic features), and amputation-specific instruments such as the Trinity Amputation and Prosthesis Experience Scales (TAPES) measure interference and prosthetic use. Examination evaluates the residual limb for surgical site healing, suture line, neuroma (Tinel sign at residual nerve ending), heterotopic ossification, vascular status, and prosthetic fit. Imaging is reserved for suspected residual limb pathology: ultrasound or MRI for neuroma localization, plain radiograph for heterotopic ossification, and Doppler studies for vascular compromise. Psychological screening with PHQ-9, GAD-7, and PCL-5 is standard given the high comorbidity. Multidisciplinary assessment in an amputee or pain clinic produces an integrated treatment plan combining pain medicine, prosthetics, physical therapy, and behavioral health.
Outcomes are variable but improving with modern multimodal care. About 30-50% of patients experience clinically meaningful improvement (≥30% pain reduction) with optimized pharmacotherapy and mirror or graded motor imagery alone; 60-75% with combined approaches including TMR or neuromodulation in selected cases. Phantom pain frequency and intensity typically decline over the first 1-2 years post-amputation; about 30% of amputees still experience moderate-to-severe phantom pain at 5 years. Predictors of better outcome include lower pre-amputation pain, prompt prosthetic fitting, perioperative regional anesthesia, absence of major depression, and engagement with rehabilitation. Predictors of worse outcome include high catastrophizing, PTSD, isolation, and poor prosthetic fit. Even when complete pain resolution is not achieved, function, work participation, and quality of life can improve substantially with comprehensive care.
Pain medicine, physical medicine and rehabilitation, and surgical specialists (orthopedic, plastic, neurosurgery) at amputation-experienced centers offer the strongest outcomes. Surgical options such as targeted muscle reinnervation require specific expertise. Multidisciplinary amputation clinics integrate pain, prosthetics, rehabilitation, and behavioral health under one program.
Find specialists →Acute postoperative phantom sensations typically appear within hours to days of surgery. Phantom pain often peaks at 1-3 months, partially declines by 6-12 months, and stabilizes over 1-2 years. With modern multimodal care, meaningful improvement typically emerges within 4-12 weeks of starting therapy. Mirror therapy effects may appear within 4 weeks. Targeted muscle reinnervation surgical effects develop over 3-6 months as reinnervation progresses.
Graded aerobic and resistance exercise is safe and beneficial. Aim for 150 minutes per week of moderate aerobic activity adapted to amputation level (arm cycling, stationary cycling with prosthesis or one-leg, swimming). Include two sessions of resistance training. Maintain prosthetic gait training and balance work to reduce falls. For upper-limb amputees, contralateral limb strengthening prevents overuse injury. Consult a prosthetist before adopting new activities to avoid socket-related injury.
Look for board certification in pain medicine, physical medicine and rehabilitation, or relevant surgical subspecialty, plus experience in amputee care. Major academic centers, Veterans Affairs amputation system of care (US), and specialized limb-loss clinics offer access to TMR, neuromodulation, and integrated rehabilitation. The Amputee Coalition and similar bodies maintain provider directories.
Medically reviewed by AIHealz Medical Editorial Board · May 13, 2026
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