Losing a limb does not always mean losing the sensations associated with it. For some amputees, pain can continue to be felt in a hand, arm, leg, or foot that is no longer physically present. Known as phantom limb pain (PLP), the condition can affect everyday life in ways that are often difficult for others to understand. With September observed as Pain Awareness Month, understanding the science behind this experience can help those living with it recognise the condition and seek the right support.
The condition can affect a person well beyond the physical sensation itself. Dr Amarnath Reddy B, consultant in pain management at Yashoda Hospitals, highlights its wider impact on everyday life. “After amputation, approximately two-thirds of people experience PLP, with pooled estimates of 64 percent. PLP can interfere with sleep, mobility, prosthetic use, employment, and social activities, and can also cause physical pain in the missing limb. This can lead to anxiety, depression, and a lower quality of life,” says Dr Amarnath.
The sensation can feel very different from one person to another and may not always be easy to describe. Dr Joy Mounica, consultant neurologist at Renova Hospitals, Langar Houz, explains the different ways it can be experienced. “PLP is described as the perception of pain originating from a limb that has been amputated or is otherwise absent. PLP can vary in intensity, duration, and quality, ranging from throbbing or stabbing sensations to burning or cramping feelings. PLP typically occurs within six months after limb loss. High prevalence rates are seen in lower limb amputations,” shares Dr Joy.
Several factors can influence how a person experiences pain following an amputation, making each case different. Dr Amarnath outlines the range of treatments available depending on the individual’s needs. “Gabapentinoids, antidepressants, opioids, NMDA receptor antagonists, physical and occupational therapy, mirror therapy, nerve blocks, neuromodulation (rTMS, tDCS, spinal cord or peripheral nerve stimulation), and, in certain situations, surgical interventions are among the options available today. Conventional medications frequently provide little to no relief,” he notes.
The nervous system can continue responding to changes after an amputation, which may contribute to the pain experienced by some patients. Dr Joy explains, “PLP may arise from maladaptive changes in the neuromatrix, which can generate internal patterns of pain that the brain then localises to the amputated limb.”
One approach that has gained attention is mirror therapy, which uses visual feedback to help the brain adapt to the loss of a limb. Dr Amarnath describes, “Mirror therapy creates a straightforward visual illusion in which the brain ‘sees’ both limbs moving painlessly by placing the reflection of the intact limb where the missing limb would be. Through neuroplasticity, this visual-motor feedback reduces pain signals and recalibrates maladaptive brain maps. Studies show significant pain reductions in many patients, including an RCT where 89 percent of upper-limb amputees improved. It is most useful for post-amputation PLP and is also used in complex regional pain syndrome (CRPS),” notes Dr Amarnath.
Dr Joy points to the importance of combining different forms of care. “Treatment of PLP involves a multimodal approach that combines pharmacotherapy, physical therapy, psychological interventions and adjuvant therapies such as transcutaneous electrical nerve stimulation (TENS), mirror therapy, biofeedback, acupuncture, massage and electroconvulsive therapy (ECT),” she adds.
PLP should therefore not be dismissed as something a person has to live with. With timely care, rehabilitation, psychological support and appropriate treatment, relief and a better quality of life are possible.
