Clinical presentation and management of phantom pain

Authors: J. Lejčko
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny, Centrum léčby bolesti, Fakultní nemocnice Plzeň ;  Lékařská fakulta v Plzni, Univerzita Karlova
Published in: Anest. intenziv. Med., 30, 2019, č. 1, s. 27-32


Phantom limb pain is a relatively common and disabling condition with a negative impact on the quality of life. Simultaneously with this exceptional type of pain, stump pain frequently occurs. Phantom pain is considered neuropathic pain. Clinical picture of phantom limb pain is influenced by a number of factors - pre-amputation pain, site of amputation, gender, etc. The exact pathophysiological mechanisms of phantom pain have not yet been defined. Presumably, peripheral and central neuroplastic changes involving cortical reorganization are key factor in the genesis of phantom pain. The role of ‘mirror’ neurons in the prefrontal cortex has been proposed. Many treatments have been tested but none of them are specific for phantom pain. The relevance of pre-emptive analgesia in the prevention of phantom limb pain is the subject of clinical research. The best treatment results have been achieved by a multimodal approach.


phantom pain – stump pain – neuroplasticity – multimodal therapy


1. Louis ED, York GK. Weir Mitchell's observations on sensory localizacion and their influence on Jacksonian neurology. Neurology. 2006;66:1241–1244.

2. Ketz AK. The experience of phantom limb pain in patients with combat-related traumatic amputations. Arch Phys Med Rehabil. 2008;89:1127–1132.

3. Richardson C, Glenn S, Nurmikko T, Horgan M. Incidence of phantom phenomena including phantom limb pain 6 month after major limb amputation in patients with periferal vascular disease. Clin J Pain. 2006;22:353–358.

4. Flor H, Nikolajsen L, Jenaswen TS. Phantom limb pain: a case of maladaptive CNS plasticity? Nat Rev Neurosci. 2006;7:873–881.

5. Baron R. Mechanisms of disease: neuropathic pain-a clinical perspective. Nat Clin Pract Neurol. 2006;2:95–106.

6. Ramachandran VS, Brang D, McGeoch PD. Dynamic reorganization of referred sensations by movements of phantom limbs. Neuro Report. 2010;21:727–730.

7. Bosmans JC, Geertzen JHB, Post WJ, et al. Factors associated with phantom limb pain: a 31/2-year prospective study. Clin Rehab. 2010;24:444–453.

8. Schley MT, Wilms P, Toepfner S. Painful and nonpainful phantom and stump sensations in acute traumatic amputees. J Trauma. 2008;65:858–864.

9. Hanley MA, Jensen MP, Smith DG, et al. Preamputation pain and acute pain predict chronic pain after Loir extremity amputation. J Pain. 2007;8:102–109.

10. Hirch AT, Dillwoerth TM, Ehde DM, Jensen MP. Sex differences in pain and psychological functioning in persons with limb loss. J Pain. 2010;11:79–86.

11. Karanikolas M, Aretha D, Tsolakis I. Optimized perioperaive analgesia reduces chronic phantom limb pain intenzity, prevalence, and frequency: a prospective, randomized, clinical trial. Anesthesiology. 2011;114:1144–1154.

12. Borghi B, D'Addabbo M, White PF. The use of prolonged peripheral neural blockade after low extremity amputation: the effect on symptoms associated eith phantom limb syndrome. Anesth Analg. 2010;111:1308–1315.

13. Attal N, Cruccu G, Haanpää M, et al. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol. 2006;13:1153–1169.

14. Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14:162–73.

15. Kolektiv autorů: Metodické pokyny pro farmakoterapii bolesti. Bolest. 2016;19(Suppl. 1).

16. 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;24:455–462.

17. Huse E, Larbig W, Flor H, Birbaumer N. The effect of opi­oids on phantom limb pain and cortical reorganization. Pain. 2001;90:47–55.

18. Giuffrida O, Simpson L, Halligan PW. Contralateral stimulation, using TENS, of phantom limb pain: two confirmatory cases. Pain Med. 2010;11(1):133–141.

19. Ramachandran VS, Rogers-Ramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proceedings of the Royal Society B: Biological Sciences. 1996;263:377–386.

20. Viswanathan A, Phan PC, Burton AW. Use of spinal cord stimu­lation in the treatment of phantom limb pain: case series and review of he literature. Pain Pract. 2010;10:479–484.

21. Cruccu G, Aziz TZ, Garcia-Larrea L, et al. EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol. 2007;14:952–970.

22. Rasmussen KG, Rummans TA. Electroconvulsive therapy for phantom limb pain. Pain. 2000;85:297–299.

23. Karanikolas M, Aretha D, Tsolakis I, et al. Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency: a prospective, randomized, cinical trial. Anesthesiology. 2011;114:1144–1154.

Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account