Non-surgical Management of Phantom Limb Pain: Current and Emerging Clinical Approaches

  • Published: 28 February 2023
  • Volume 11 , pages 16–24, ( 2023 )
  • Amy L. de Jongh Curry 1 ,
  • Morgan E. Hunt 2 , 3 ,
  • Paul F. Pasquina 4 ,
  • Robert S. Waters 5 &
  • Jack W. Tsao   ORCID: 6  

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Purpose of Review

This article focuses on a review of the non-surgical treatment options for patients with phantom limb pain (PLP).

Recent Findings

Based on a review of the published literature over the past 5 years, the most promising evidenced-based therapies involve sensory feedback to the user through either visual or tactile stimulation.

Of these, the most effective therapies include mirror therapy, phantom motor imagery, and phantom motor execution and, therefore, should be considered when treating individuals with PLP.

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Department of Biomedical Engineering, University of Memphis, Memphis, TN, USA

Amy L. de Jongh Curry

The Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

Morgan E. Hunt

The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA

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Paul F. Pasquina

Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA

Robert S. Waters

Department of Neurology, NYU Grossman School of Medicine, NY, New York, USA

Jack W. Tsao

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de Jongh Curry, A.L., Hunt, M.E., Pasquina, P.F. et al. Non-surgical Management of Phantom Limb Pain: Current and Emerging Clinical Approaches. Curr Phys Med Rehabil Rep 11 , 16–24 (2023).

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Immersive Low-Cost Virtual Reality Treatment for Phantom Limb Pain: Evidence from Two Cases

Elisabetta ambron.

1 Laboratory for Cognition and Neural Stimulation, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

Alexander Miller

Katherine j. kuchenbecker.

2 Haptic Intelligence Department, Max Planck Institute for Intelligent Systems, Stuttgart, Germany

Laurel J. Buxbaum

3 Cognition and Action Laboratory, Moss Rehabilitation Research Institute, Philadelphia, PA, United States

H. Branch Coslett

Up to 90% of amputees experience sensations in their phantom limb, often including strong, persistent phantom limb pain (PLP). Standard treatments do not provide relief for the majority of people who experience PLP, but virtual reality (VR) has shown promise. This study provides additional evidence that game-like training with low-cost immersive VR activities can reduce PLP in lower-limb amputees. The user of our system views a real-time rendering of two intact legs in a head-mounted display while playing a set of custom games. The movements of both virtual extremities are controlled by measurements from inertial sensors mounted on the intact and residual limbs. Two individuals with unilateral transtibial amputation underwent multiple sessions of the VR treatment over several weeks. Both participants experienced a significant reduction of pain immediately after each VR session, and their pre-session pain levels also decreased greatly over the course of the study. Although preliminary, these data support the idea that VR interventions like ours may be an effective low-cost treatment of PLP in lower-limb amputees.


Individuals who undergo amputation commonly experience the sensation that the missing extremity is still present, a phenomenon known as a “phantom limb” (PL) ( 1 ). A significant proportion of individuals who experience a PL—from 65 to 70% in many studies—also experience persistent and debilitating pain in the missing limb, a condition known as phantom limb pain (PLP) ( 2 , 3 ). PLP typically appears immediately after or within 1 week of amputation, but in rare cases it has been reported to begin months or years after amputation ( 1 ). Its frequency and characteristics vary across individuals. PLP can be sporadic or steady, and it can be experienced as burning, tingling, throbbing, cramping, squeezing, shocking, or shooting ( 4 ). Furthermore, some individuals may also report foreshortening of the PL, a phenomenon known as “telescoping,” which is associated with an increase in PLP ( 5 , 6 ).

Although the cause of PLP is unclear, a number of hypotheses regarding the etiology of the disorder have been advanced. Some accounts attribute the deficit to peripheral nervous system disorders such as neuromas ( 5 , 7 ). The transection of the nerve with the limb amputation and the consequent development of neuromas can induce ectopic discharges and the sensation of pain. The fact that anesthetic blockade of the nerve reduces pain in some amputees ( 8 ) indicates that this explanation accounts for PLP in some instances. However, not all individuals experience a reduction in PLP from the use of anesthetic at the residual limb ( 9 ). This observation, in addition to the occurrence of PLP in individuals with congenital absence of an extremity ( 10 , 11 ), suggests that the disorder arises from more central alterations.

It has been proposed that the amputation of a limb may induce a “cortical remapping” at the level of somatatosensory and motor cortices. Animal studies have shown that amputation of a limb induces neighboring areas to invade the cortical regions that represent the amputated body part ( 5 , 12 , 13 ). This interpretation has been supported with behavioral and neuroimaging evidence in humans, which showed that tactile stimulation of the face (represented cortically in close proximity to the hand area), but not of other parts of the body, is perceived as stimulation of the PL and induces an activation of the hand area ( 14 ). This cortical remapping of somatosensory as well as motor cortex has been proposed as one of the possible mechanisms responsible for PLP ( 15 , 16 ). Flor and colleagues ( 17 , 18 ) showed that PLP, but not PL phenomena per se , correlated with the level of cortical remapping. A possible mechanism for this cortical remapping is the “noise” produced by neuromas or the loss of C-fibers after amputation ( 5 ).

An alternative account links the cortical remapping interpretation with the observation that individuals who experience PLP often noted pain before the amputation ( 19 ). This theory proposes the existence of some memory for pain mechanisms ( 5 ). The long-lasting activation of nociceptors prior to amputation of the limb may induce alterations at the level of primary sensory cortex ( 5 ) or at multiple sites in the “pain matrix” ( 4 ). With limb amputation and consequent cortical remapping, expansion of the neighboring areas into the cortical area of the amputated limb might induce reactivation of the memory for pain that is coded in these regions and elicit the experience of PLP ( 5 ). While this interpretation can account for PLP in some individuals who experience chronic pain ( 19 ), it cannot explain PLP in individuals with amputation from trauma.

Yet another account attributes PLP to a disruption of the primary sensory–motor representation of the missing extremity, a phenomenon sometimes called “maladaptive plasticity” ( 5 , 20 ). This interpretation rests on the fact that the ability to generate motor commands remains intact after the amputation. Indeed, studies have documented preserved activation of motor areas in individuals who experience a PL ( 21 ), as though the limb were still present ( 22 ). The motor commands sent to an amputated limb, however, fail to generate the visual, auditory, proprioceptive, and tactile afferent signals that the brain expects ( 1 , 23 ). The lack of correspondence between action plans and sensory feedback from action is hypothesized to introduce imprecision, or “noise,” in the representation of the extremity, and this imprecision may manifest as pain. A variant of this account has been suggested by recent evidence from Makin and colleagues [e.g., Ref. ( 24 , 25 )] that the integrity of hand cortical representations (and disconnection of these intact representations from sensory input) is associated with PL or PLP phenomenon. Finally, mood, anxiety, and other psychological factors also play a role in PLP ( 5 , 7 ).

These varied explanations for PLP are not mutually exclusive and may together account for the observed differences in PLP across individuals ( 6 ). The variability in PLP etiology and characteristics may also explain why certain individuals respond more or less well to particular treatments ( 26 ). Indeed, several different therapies have demonstrated benefit in some individuals, but none have been widely effective. PLP therapies vary from pharmacological options such as anesthetics ( 26 ), antidepressants ( 7 , 26 ), and botulism toxin injections ( 7 ) to interventional treatments such as spinal cord stimulation ( 27 ), surgery ( 26 ), nerve block ( 26 ), neuromodulation ( 27 ), sensory discrimination ( 28 ), mental imagery ( 29 ), mirror therapy ( 26 , 30 ), and virtual reality (VR) ( 12 ) treatments.

A number of these PLP therapies, including sensory discrimination, mental imagery, mirror therapy, and VR, attempt to normalize the cortical representation of the missing limb and improve the correspondence between actual and predicted sensory feedback. For instance, the use of anesthetic on the residual limb seems to be effective at reducing PLP when the injection induces a cortical reorganization ( 9 ). Sensory discrimination therapy uses tactile perception tasks presented at the residual limb to provide inputs from the amputated area and may reverse the cortical reorganization that is generating the pain ( 28 , 31 ). The mirror box technique has also proven to be successful in reducing pain for some individuals ( 32 , 33 ). In this intervention, a mirror is placed at the subject’s midline, and the subject watches the normal limb in the mirror while attempting to move both limbs in synchrony ( 34 ). Seeing the missing limb increases the individual’s sense of control of the PL and may reduce pain ( 6 , 35 ). A limitation of the mirror box technique is the poor verisimilitude of the sensory feedback provided from the missing limb. The participant may have the visual illusion that the phantom extremity is moving, but the apparatus is crude and the illusion often not compelling. Patients cannot independently control the mirrored extremity, so only symmetric actions can be modeled.

Some of these limitations can be overcome using VR because this technology can provide visual input that is more varied and realistic than that provided by a mirror ( 36 – 38 ). Indeed, Ortiz-Catalan et al. ( 36 ) recently reported the experiences of a single subject with chronic upper-limb phantom pain who had failed mirror therapy. They employed a VR system to create an image of the missing hand on a computer monitor and used surface EMG data from the residual limb to enable the subject to control the hand and perform a series of reaching movements. The use of this system reduced the subject’s pain ( 36 ). Similar beneficial effects have also been obtained in larger samples of PLP patients ( 12 , 37 – 39 ), reinforcing the potential utility of VR in PLP treatment. Mercier and Sirigu ( 38 ) reported an average pain reduction of 38% in eight individuals with upper-limb amputation who were trained to use the residual limb to match the movements of a virtual limb created from a mirror image of the intact limb. Similarly, Perry et al. ( 39 ) showed an average pain reduction of 40% in five upper-limb amputees who were trained with 20 sessions of active and passive imitation of an avatar’s movements. Using motion-tracking of the residual limb to create and control a virtual limb, Cole et al. ( 40 ) showed a beneficial effect after a single session of VR treatment in 10 of 14 individuals with PLP; furthermore, average pain reduction was 64%. These data suggest that VR systems that allow participants to directly control the virtual limb have significant potential to reduce PLP ( 40 ).

In the present study, we describe our preliminary findings in the treatment of PLP using a low-cost VR system that provides an immersive and responsive virtual representation of the intact and missing lower extremities that the user can control through natural motion of his or her intact and residual limbs. Two individuals who experienced PLP after leg amputation participated in a series of VR treatment sessions wherein they played custom games that require the use of both legs. The data suggest that this approach has substantial potential as a treatment for PLP.

Materials and Methods

Case studies.

Subject 1 was a late-middle-aged, hypertensive, diabetic person who underwent a right transtibial amputation for peripheral vascular disease 11 months before treatment. Subject 1 had a painful, non-healing foot wound for 6 months prior to amputation. After amputation, the pain persisted in the PL without change in character or severity. In the pretesting session, Subject 1 reported pain that varied in intensity from 2 to 10 and averaged 6 out of 10. All such ratings were gathered using a visual analog scale from 0 (no pain) to 10 (maximum level of pain). There were no factors that consistently altered the intensity of the pain. Subject 1 had tried numerous medication regimens without benefit. This participant could flex and extend his/her residual limb at the knee and did not experience telescoping of the PL. Subject 1 participated in only two sessions because of a newly diagnosed serious medical condition.

Subject 2 was a middle-aged person with peripheral vascular disease who underwent left transtibial amputation because of gangrene in the left foot. At the time of surgery, Subject 2 noted severe burning/aching pain in the left foot. That pain persisted in the PL that developed after the amputation. Subject 2 reported a clear sense of persistence of the lower leg and foot and felt that s/he could flex and extend the phantom foot but not wiggle its toes. After failing multiple therapies, including gabapentin, narcotics, tricyclics, and nerve blocks, Subject 2 was enrolled in our research project 7 months after the amputation. In the pretesting session, this participant reported a pain range from 4 to 10 out of 10, with an average of 7 out of 10. Subject 2 took part in four VR sessions over the course of approximately 6 weeks.

The format of each session was identical: after the VR apparatus was set up, the participant rated current pain on the same 0 to 10 scale and then trained with our VR system for approximately 1 h. The participants sat in their own wheelchair throughout the session. Treatment always started with at least 20 min of the most active game ( Quest for Fire , described below), as it required vigorous use of the amputated limb. For the remaining time, the participant was free to choose which games to play. At the end of the hour, the participant was asked to rate the present severity of pain on the same 0 to 10 scale. To assess the design of the VR system, participants were asked to rate the Quest for Fire and Chess games on the System Usability Scale ( 41 ) after the final VR treatment.

All experimental procedures were approved by the University of Pennsylvania Institutional Review Board under protocol #823287. During recruitment, participants were told they could withdraw from the study at any point without providing an explanation and without any consequences. Enlisted participants gave informed consent and were compensated.

VR Hardware and Software

As our aim was to develop an affordable VR treatment for individuals who experience PLP, we used low-cost, high-quality components that are commercially available. First, the VR environment was presented using an Oculus Rift DK2 headset, a head-mounted display that provides three-dimensional graphical output. This headset adjusts the user’s view to match the orientation of his or her head in real time, providing an immersive and compelling view of the virtual environment. Second, we rigged a generic humanoid avatar (a robot) to allow the user to control the rotation of the hip and knee joints of both legs in a seated position. See Figure ​ Figure1 1 for a screenshot of the user’s view in the Quest for Fire game. The avatar’s legs were controlled using four nine-degree-of-freedom inertial measurement units (IMUs) that were each mounted on a board and attached to the tops of the user’s thighs and the fronts of the anterior shins (directly below the knee joint) using stretchable fabric bands, as shown in Figure ​ Figure2. 2 . To estimate the orientation of each of the four moving leg segments, Arduino microcontrollers were used to send readings from the IMUs to the computer, using a program written in the Arduino Programming language. A script written in Unity was then used to filter the readings from all four IMUs. The user could precisely control hip flexion/extension, hip adduction/abduction, and knee flexion/extension of each leg independently. Many events in each game caused sounds to help the user understand game contingencies and further increase the immersiveness of the system. These sounds were presented through the laptop speakers.

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Participants’ view of the (A) Quest for Fire , (B) Web browser , and (C) Chess games. The Checkers game looks very similar to Chess .

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Subject 2 using the virtual reality system.

During the VR treatment, participants could play four games: Quest for Fire, Web Browser, Chess , and Checkers (see Figure ​ Figure1). 1 ). Loosely based on the Nintendo game Sokoban that was released in 1982 by Thinking Rabbit, Quest for Fire presents the player with a VR labyrinth environment. The avatar sits on a mobile chair and maneuvers around the virtual environment by moving their virtual legs (see Figure ​ Figure1). 1 ). The goal of each level is to reach the fiery portal at the end of the labyrinth by pushing crates into pits so that they no longer impede one’s path. This game has 17 levels that increase in complexity. Sounds effects were provided for crates sliding across the floor, crates falling into pits, the motion of the user’s chair, and the user entering a portal. In the Web Browser virtual environment, the user is presented with a virtual keyboard and a computer screen showing content from the Internet. Leg motions enable the user to navigate the Internet by moving the cursor and typing on a virtual keyboard. Click sounds were provided when participants clicked the VR keyboard or VR computer screen. In Chess and Checkers , the participant plays against a standard chess or checkers algorithm by identifying a piece to move using the virtual legs and then directing the virtual legs to the location to which he or she wants to move the piece. Click sounds were provided when participants clicked on a piece, along with sounds indicating the piece’s movement. Playing the games required the user to lift the legs by rotating at the hips, flex the knees, and execute different coordinated movements; therefore, participants were instructed to take breaks whenever they needed. Neither participant interrupted a session as a result of physical or mental fatigue.

As shown in Figure ​ Figure3, 3 , both subjects exhibited a substantial decline in pain immediately after each VR treatment session. Subject 1’s post-session (versus pre-session) pain intensity ratings diminished by 100% in both session 1 and session 2, while Subject 2’s post-session pain ratings diminished by an average of 93.7%. All but one of the six recorded post-session pain scores were at the minimum value of 0 out of 10, indicating no pain at all.

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Pain intensity ratings from pretesting and at the beginning and end of each session (S). Gray squares indicate Subject 1’s ratings, and black circles indicate Subject 2’s ratings.

Furthermore, both participants showed a reduction in pretreatment pain severity in subsequent sessions and a progressive decrease of PLP across sessions. This trend was evident for both participants: Subject 1’s pain ratings decreased by 22% from the beginning of session 1 to the beginning of session 2, whereas Subject 2’s pain ratings showed a decrease of 67% from the beginning of session 1 to the beginning of session 4.

Qualitative feedback given during the experiment was also informative. Both subjects were highly enthusiastic about the system and were eager to continue the study, but they could not continue for health (Subject 1) and personal (Subject 2) reasons. Finally, it should be noted that Subject 2 reported that his overall level of activity improved dramatically over the course of the experiment. For example, after two sessions Subject 2 walked to the local grocery store using a lower-limb prosthesis for the first time.

Data from the System Usability Scale ( 41 ) demonstrated generally favorable ratings for usability of the system. Subject 2 scored the Quest for Fire and Chess games 70 and 83 out of 100, respectively; Subject 1 scored the same activities 40 and 78, respectively. Three of these four ratings are within the acceptable range (above 50 out of 100). Informal comments from Subject 1 indicated that the low rating for Quest for Fire reflected the frustration s/he encountered when learning to make the avatar move around the labyrinth.

Information regarding the sense of agency of the VR limb, the point during the session at which participants noted a reduction in PLP, and the possible association between level of fatigue and PLP was not obtained.

Preliminary data from the two participants suggests that our VR system may be a useful therapy for PLP. Indeed, both individuals reported a sizable decrease in PLP immediately after each 1-h-long VR session and a progressive reduction of pretest pain across sessions. As noted in the Section “ Introduction ,” prior work has demonstrated that VR may be of benefit in the treatment of PLP ( 38 – 40 ). Although the data must be interpreted with caution given the small sample size in our study, as well as in other investigations ( 36 , 37 ), we note that the pain reduction achieved within a session was larger in our subjects than that reported in some previous studies ( 12 , 40 , 42 ), as both individuals were pain free after most VR sessions. Our subjects also did not report an increase in pain during the training, as had been observed in some previous research ( 38 ).

Although formal data are lacking, we believe that the variety and quality of the activities offered to the participants may have contributed to our promising results. Subject engagement may have been a limiting factor in the success of other VR systems developed to alleviate PLP, which in turn may be attributable to the repetitive and simple nature of the tasks implemented in some investigations. For example, Perry et al. ( 39 ) asked subject to pronate or supinate the wrist, and other investigators employed a simple reach and grasp task ( 40 , 42 – 44 ) or press and release of a foot pedal ( 40 ). Other studies that have used more entertaining VR activities, like arranging a puzzle ( 45 ) or racing games ( 36 , 46 ), have offered only a single game during the training. Our subjects were afforded a suite of games, were permitted to allocate most of their time according to their interests, and reported the tasks to be interesting and fun. Current research with our system is exploring the potential contributions of factors such as engagement, sense of agency, and level of effort to any observed treatment effects.

By using IMUs attached to the individual’s thighs and shins, our VR system allowed subjects to perform bilateral and unsynchronized leg movements, thereby providing subjects with the experience of being in full control of the virtual PL. This setup contrasts with many studies in which the visual image of the intact limb was transposed into the space of the phantom to create the virtual limb; such systems permit only bilateral synchronized movements [( 38 , 39 , 45 ), but see Ref ( 40 ). for a counter-example]. As argued by Perry et al. ( 47 ), VR approaches that provide more lifelike feedback may be substantially more effective because they enable more diverse limb movements and provide richer sensory cues.

Importantly, our system uses the Oculus Rift headset to generate high-quality immersive VR. Many previous studies were carried out in non-immersive settings, with the virtual or augmented environment presented as a two-dimensional image on a computer monitor ( 36 , 39 , 46 ) or as a mirror reflection ( 38 , 42 , 44 , 45 ). Although several recent studies have also employed immersive VR ( 36 , 42 – 44 ), the environment presented in these studies was typically simple, such as a basic 3D world where a single unique object was presented. The rich virtual environments employed in our research may facilitate treatment benefit by increasing motivation and/or providing more lifelike visual cues.

Finally, our system is relatively easy to use. VR systems that employ myoelectric recording from the residual limb to create the VR limb ( 36 , 46 , 48 ) have used up to eight electrodes, which take time and skill to place. The use of simple inertial sensors represents a practical advantage and reduces the need for supervision; our system requires only a few minutes to set up and does not require technological expertise to operate. We believe it would be feasible to create a version that could be used at home without assistance, opening the door for a low-cost, convenient, effective PLP management strategy.

Although our investigation was not designed to explore the pathophysiology of PLP, we believe our data are in general agreement with the hypothesis that PLP is due to the incongruence or lack of correspondence between predicted and actual sensory and motor feedback regarding the extremity ( 5 , 20 ). Following this line of reasoning, if loss of sensory feedback causes a degradation of sensory–motor representations relevant to the missing extremity, interventions that provide feedback relevant to the planned action of the missing extremity should reduce pain ( 15 , 16 ).

A major limitation of our study is the small sample size. Still, it is encouraging that both participants responded strongly and reliably to our treatment. A further limitation of the present study is that our VR system provides visual and audio feedback, but not haptic (touch) feedback. As previous works suggest that haptic feedback increases the likelihood of improvement in PLP in some individuals ( 42 – 44 ), we intend to include haptic feedback in a future version of our system. An additional potential limitation is the fact that the avatar had robot-like rather than lifelike legs; although it is often assumed that “realism” enhances the effects of VR, it is noteworthy that our system achieved strong effects leg depictions that were responsive but not lifelike. A final limitation is that one of our subjects rated one game ( Quest for Fire ) as low in usability.

Our VR system continues to evolve; we have made several changes to the Quest for Fire software to improve its ease of use. Additionally, we have developed a version of the hardware that incorporates electromagnetic motion tracking rather than IMU-based tracking of leg position; this modification will address the fact that the IMU signals tended to drift during vigorous motion, contributing to participant frustration. We have also improved both visual and auditory feedback; for example, the new version of the system offers a more realistic reproduction of the limbs. Finally, we have upgraded the VR hardware with a new Oculus Rift that features built-in head position tracking and headphones, both of which increase the immersiveness of the VR environment. The upgraded system is currently being tested in a larger cohort of subjects who experience PLP.

To conclude, our VR system provided participants with an immersive VR experience while they played a variety of entertaining games using both legs. This system has shown clear potential for the treatment of PLP, achieving a substantial reduction in PLP in two individuals over only two to four sessions. Because of its low cost and ease of use, this system is a potential prototype for home-based treatment of PLP. Finally, the positive results in the treatment of PLP reported here and in previous studies support the view that VR may be a useful treatment for different forms of chronic pain or other acquired brain disorders, such as stroke ( 49 ) or spinal cord injury ( 50 ).

Author Contributions

EA wrote a first draft of the manuscript and conducted the testing sessions. AM designed and implemented the VR system. KK designed the study and the VR system, and revised the manuscript. LB designed the study and revised the manuscript. HC designed the study, conducted the testing sessions and revised the manuscript.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Funding. This work is supported by NIH grant R21NS099645 awarded to HC.

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Managing Phantom Pain

Managing Phantom Pain

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Phantom limb pain (PLP) refers to ongoing painful sensations that seem to be coming from the part of the limb that is no longer there. The limb is gone, but the pain is real.

The onset of this pain most often occurs soon after surgery. It can feel like a variety of things, such as burning, twisting, itching or pressure. It is often felt in fingers or toes. It is believed that nearly 80 percent of the amputee population worldwide has experienced this kind of pain.

The length of time this pain lasts differs from person to person. It can last from seconds to minutes, to hours, to days. For most people, PLP diminishes in both frequency and duration during the first six months, but many continue to experience some level of these sensations for years.

People are often reluctant to tell anyone that they are experiencing PLP or phantom limb sensations, for fear that they will be considered “crazy.” However, it is important to report these pains as soon as you begin to experience them so treatment can be started.

What Causes Phantom Limb Pain?

Unlike pain that is caused by trauma directly to a limb, PLP is thought to be caused by mixed signals from your brain or spinal cord. This is an important concept to consider, because the treatment for this pain has differences from the treatment you would receive for other kinds of pain. New therapies for PLP all involve trying to change the signals from your brain or spinal cord.

As with any other kind of pain, you may find that certain activities or conditions will trigger PLP. Some of these triggers might include:

  • Urination or defecation
  • Sexual intercourse
  • Cigarette smoking
  • Changes in barometric pressure
  • Herpes zoster
  • Exposure to cold.

If you notice any particular thing triggering an episode of PLP for you, let your healthcare provider know. Some triggers can be avoided – for example, you can prevent constipation or stop smoking. For other triggers, you will just have to understand and treat accordingly. You will not be able to prevent the barometric pressure from changing, but you will be able to understand that your PLP might be more severe on days with big shifts in the weather!

Treating Phantom Limb Pain

Treating PLP effectively takes a multipronged approach. Medications of several different categories in combination with non-medication treatments seem to be most effective. This combination of medication/non-medication is similar to treating other painful conditions.

For instance, if you broke your leg, you would expect to take narcotic pain medication, at least for a while. You would also elevate your leg and put ice on it.

For PLP pain management, you will take medications directed specifically toward interrupting the pain signals in your brain or spinal cord as well as using certain non-medication therapies, which also work on your brain’s interpretation of these signals.

Medications for Phantom Limb Pain

There are many different categories of medications that can decrease your pain. Each of them is thought to work on different kinds of pain sensations. The categories of some of the medications you might be given include:

  • Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs)
  • Opioids (narcotic pain medications)
  • Antidepressants
  • Anticonvulsants
  • Beta-blockers
  • Muscle relaxants.

Some of these medications work best if taken in combination with other medications and if given at certain times of the day. The antidepressants typically used work best if given at bedtime, and are often taken at the same time as the anticonvulsants. Finding the right medications – with the fewest side effects – will require you and your healthcare provider to work closely together.

Non-Medication Treatments for Phantom Limb Pain

Alternative/complementary therapies can be helpful for the reduction of PLP. These include:

  • Acupuncture
  • Massage of the residual limb
  • Use of a shrinker
  • Repositioning of the residual limb by propping on a pillow or cushion
  • Mirror box therapy
  • Biofeedback
  • TENS (transcutaneous electrical nerve stimulation)
  • Virtual reality therapy

For further discussion of these non-medication treatments for phantom pain, click here to access an article addressing the topic from the Amputee Coalition’s I nMotion magazine.

There are also many videos online demonstrating how these therapies have worked for others and how they might work for you.

What You Need to Remember

  • Phantom limb pain/sensation is common for most people after amputation surgery. Symptoms generally improve over time.
  • Your phantom limb pain/sensation can be managed so that it does not overwhelm your life.
  • The goal of pain management is to reduce pain levels to allow you to get you back to living and enjoying life again.
  • Work closely with your healthcare team to create and maintain the pain management plan that works for you.
  • When possible, avoid things that trigger your phantom limb pain/sensation.
  • Use the Amputee Coalition Web site ( ) to learn about new therapies and to let others know if a new therapy has worked for you.

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Phantom Pain

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Condition: Phantom pain is the feeling of pain in an organ or limb that is not physically present.

Background: Phantom pain occurs exclusively after limb amputation or after removal of organs, such as breast, eye, penis, or tongue. Approximately 60-80% of patients experience phantom pain within the first week after amputation, and this pain improves over time. Originally, phantom pain was thought to be psychological, but now doctors know that this pain originates from the spine and brain.

Risk Factors: Phantom pain is more common when pain was present in the missing limb before amputation. There is a greater incidence in patients with shorter stumps, lower leg amputations, and amputation of both legs. Children and those missing limbs at birth experience phantom pain less frequently.

History and Symptoms: Phantom pain generally occurs in the more distant parts of the missing limb, including the wrist, fingers, ankles, feet, or toes. The pain is described as intermittent burning, stabbing, prickling, shooting, or electrical. The reasons for amputation and the amount of pain that was present before and after the surgery should be considered.

Physical Exam: The physical exam will focus on the range of motion and measurements of the residual limb. Sensation, movement, and blood flow should also be assessed in the extremities on both sides of the body. If a prosthetic limb is used, the physical exam will evaluate this as well. Other potential sources of pain, including wounds, neuromas, or nerve problems, will be examined.

Diagnostic Process: Blood samples can be analyzed for signs of infection. X-rays of the limb are useful to evaluate the bony elements in the extremity. Tests of blood flow and nerve function in the remaining limb may be conducted. Ultrasound can be used to look for painful nerve endings and may be performed in the office of a physical medicine and rehabilitation (PM&R) physician.

Rehab Management: Physical therapy is an important part of phantom pain management. Also important are proper stump care and prosthetic limb fit which can be coordinated between a PM&R physician and the person who makes the prosthetic limb. PM&R physicians can also prescribe medications to help the pain including antidepressants, seizure medications, over the counter pain medications and prescriptions pain medications. Massage, movement, acupuncture and transcutaneous electrical nerve stimulation (TENS) may also be helpful. Other parts of treatment can include mirror box imagery treatment, compression, desensitization techniques, biofeedback, coping strategies, and skin care. Psychological support may also be necessary.

Other Resources for Patients and Families: PM&R physicians are experts on prosthetic planning and prescribing and can provide patients and families counsel on the nature and course of the pain. They can also assist with education about stump and prosthesis care, relaxation, and coping skills.

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Disease/ Disorder

Phantom pain is a noxious sensory perception of pain in an organ or limb that is physically not present. Stump pain is pain localized in the residual limb, and phantom sensation is the non-painful sensation of the presence of a missing limb.

Phantom limb sensation may be present as a result of spinal cord injury, amputation, or congenital deficiency. Phantom pain is almost exclusively experienced after amputation. It has also been observed after surgical removal of organs such as breast, eye, penis, and tongue.

Epidemiology including risk factors and primary prevention

Phantom pain is experienced by up to 80% of post-amputation patients within the first week after amputation, with diminishing incidence over time. More commonly seen in patients suffering from pain in the amputated limb prior to its amputation. 1 In the adult population, age, gender, side, and cause of amputation do not influence the occurrence of phantom pain. There is a greater incidence in shorter residual limbs, lower extremity amputations and in bilateral amputees. 1,2 Children and congenital amputees experience phantom pain much less frequently. There is also evidence that patients with history of infection/gangrene experienced greater pain and increased interval between amputation and prosthesis fitting. 3 Phantom limb pain has been reported to have severe pain related functional impairment and diminished quality of life in 25% to 50% of patients. 21


The mechanism responsible for phantom pain is not completely understood, but it is hypothesized that peripheral factors, spinal plasticity and cerebral reorganization all contribute. Peripherally cut nerves develop neuromas, which show increased sodium channel expression, causing spontaneous and abnormal evoked potentials with sensory stimulation. 4 C fibers in the dorsal horn may degenerate after peripheral injury, being replaced with A fibers, leading to an increased expression of substance P, a lower threshold and persistent neuronal discharge. Cortical reorganization of the primary somatosensory cortex occurs after amputation, and functional magnetic resonance imaging (fMRI) has shown a direct correlation between the pain level and degree of reorganization. 5 Therapy focusing on limb perception (such as mirror therapy and prosthesis use) could prevent, reduce, and even reverse these changes in cortical reorganization. 22 The persistence of phantom pain most likely is a multifactorial process driven by somatic, psychological, and social factors (similar to other chronic pain conditions).

Disease progression including natural history, disease phases or stages, disease trajectory (clinical features and presentation over time)

There are no distinct stages of phantom pain. Most patients have a decrease in pain over time. Patients with severe, prolonged phantom pain may develop chronic pain syndrome, with its associated multifactorial impairments.

Specific secondary or associated conditions and complications

Should symptoms persist or worsen, consider pain from neuromas, soft tissue infections, osteomyelitis, heterotopic ossification, radiculopathy, peripheral vascular disease, peripheral nerve injury, or if the amputation was a result of malignancy, recurrence.

Essentials of Assessment

Indications for amputation, pre-amputation and post-amputation pain characteristics should be elucidated. As in any evaluation of pain, it is important to consider pain intensity, location, quality, duration and timing and modulating factors. Phantom pain is generally localized in the more distal parts of the missing limb, such as wrist, palms, fingers, ankles, feet and toes. The sensations can be described as intermittent burning, stabbing, prickling or shooting. Painful phantom sensations are usually intermittent and last from seconds to minutes, but can last for hours, or even permanently. Generally, pain diminishes in both frequency and duration during the first 6 months after amputation. 20 Include questions about symptoms and behavioral changes commonly associated with pain. Since changes in pain can be both cause and effect of affective disturbances, a review of psychological symptoms is relevant.

Physical examination

A thorough neurological and vascular examination of all extremities is essential. The range of motion, length and circumference of the residual limb must also be measured. Assess upper extremity function if the lower extremity is the amputated site. Observe range of motion and sensory and motor function bilaterally. Evaluate prosthesis as well as fit and number of ply socks utilized. If lower extremity is involved, evaluate the patient’s gait. Phantom pain may be elicited by tapping over existing neuromas. The examination should evaluate other potential sources of pain, including neuromas, wounds on the residual limb, fractures, stroke, lumbar radiculopathy, myofascial pain, and other peripheral nerve syndromes.

Functional assessment

Phantom pain may lead the patient to decrease or discontinue the use of the prosthesis; it may also decrease mobility and affect cognitive, emotional, interpersonal and vocational status.

Laboratory studies

Complete blood count (CBC) showing elevated white cell count and neutrophils as well as abnormal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may indicate infection.

Plain films of the limb may be useful to evaluate the bony elements in the extremity. Plain x-ray is the preferred modality to diagnose heterotrophic ossification. MRI or ultrasound may be used if there is concern for a neuroma or soft tissue abscess/infection. MRI may also reveal additional sources of pain such as scar tissue or osteomyelitis. MRI with and without contrast is preferred for evaluation of osteomyelitis and soft tissue infection but without contrast can be adequate if contrast is contraindicated. Ultrasound is an economical and viable option to assess for most of the conditions in case MRI is unavailable or contraindicated.

Supplemental assessment tools

Vascular and electrodiagnostic studies may be useful in evaluating the differential diagnoses of peripheral vascular disease or nerve damage.

Early predictions of outcomes

Research suggests that duration and intensity of pre-amputation pain and perioperative pain are predictors of future phantom pain, with longer duration and greater severity leading to a greater risk of future development of phantom pain. 6 The severity of pain can also be partially predicted by preamputation scores of anxiety and depression. 16

Social role and social support system

Psychosocial dysfunction and depression are seen more frequently in patients suffering from chronic pain, and this is also true with phantom pain. Although phantom pain is not considered a psychological disturbance, it may be modulated by psychosocial factors. Psychological evaluation and support may be useful.

Rehabilitation Management and Treatments

Available or current treatment guidelines.

There are no specific clinical guidelines for the management and treatment of phantom limb pain. A multidisciplinary approach to phantom limb patient care is essential. Proper stump care and management must be emphasized. Prosthetic fit and alignment should be addressed. Physical therapy is also an integral part of phantom limb management. These approaches should be integrated with all aspects of pain management, which can combine pharmacologic, physical modalities, interventional, and behavioral approaches.


  • Physical modalities, such as massage, active and passive movement, and manipulation may be useful in treating the residual limb. Transcutaneous electrical nerve stimulation (TENS) and acupuncture may also be helpful.
  • Mirror box imagery has shown to significantly reduce phantom pain. 27
  • Myoelectrical prosthetic use, probably based on visual feedback, can be used. Textile, electromagnetically-acting stump liners are also shown to be therapeutic. 8
  • Desensitization, biofeedback, cognitive coping strategies, proper prosthetic management are important parts of treatment, as well as skin care and edema management.


  • Intravenous ketamine and dextromethorphan reduce wind-up-like pain, hyperalgesia and phantom pain. Memantine, another NMDA receptor antagonist, was not shown to be effective in 2 separate trials. 9
  • Intravenous calcitonin has been studied with variable results, including were variable, with one study showing early postoperative intravenous calcitonin may be effective in reducing phantom pain. 10
  • NSAIDS and Acetaminophen: Analgesic effects vary.
  • Tricyclic antidepressants, effective in treating neuropathic pain, may also be helpful in treating phantom pain. Side effects include sedation and anticholinergic effects. SNRI and SSRIs are increasing in popularity due to better side effect profile but there is limited data on its effect on phantom pain. 11
  • Anticonvulsants: Gabapentin was found to be effective in decreasing pain intensity, with limiting side effects. 23 Carbamazepine and pregabalin may be helpful in reducing phantom pain.
  • Opioids, such as morphine and methadone, are effective in reducing phantom pain. Adjuvant intervention with topical agents such as Capsaicin cream may be employed but has yet to be proven effective in well-controlled trials. 12

Minimally invasive

Although local steroid injections, dorsal root ganglion blocks, spinal cord stimulators, and intrathecal pumps may be used to relatively selectively block the dermatome affected by the phantom pain, support for these treatments by clinical research is lacking.

Percutaneous peripheral nerve stimulation of the sciatic and femoral nerves has been shown to be effective in some studies, however further research with larger patient cohorts is needed. 24

Neuromas or other causes of pain can be surgically removed; however, stump revision should be reserved for cases of obvious pathology.

Patient & family education

As with all chronic pain syndromes, both the patient and family should be counseled in the nature and course of the pain. Stump and prosthetic care, relaxation techniques, and coping skills should be emphasized.

Emerging/unique interventions

Virtual Reality and Augmented Reality have been used to treat phantom limb pain in a manner similar to mirror therapy. Patients utilize myoelectric controls on their residual limb to control a virtual limb. This has been demonstrated to be effective for the treatment of phantom pain associated with distorted movement and positioning of the phantom limb more so than typical neuropathic pain sensations. 17

Low intensity, low frequency, surface acoustic wave ultrasound treatments is currently being investigated. Surface acoustic wave ultrasound, shown to reduce pain in trigeminal neuralgia and other pain syndromes, is currently being evaluated for treating phantom pain. 13

Measurement of Patient Outcomes

Standard pain measurements and scoring systems, such as the Visual Analog Scale (VAS), may be applied to phantom limb pain. Although numerous functional outcome measurement instruments exist for amputees, none is specific for phantom pain.

Cutting Edge/ Emerging and Unique Concepts and Practice

Neurosurgically placed deep brain stimulators are effective in reducing, but not completely eliminating phantom pain.  Analgesic effects and improvement of quality of life after thalamic deep brain stimulation has been demonstrated in patients one year post-amputation. 14

Peripheral neuromodulatory and neuroprosthetic approaches have been tried by utilizing a functional prosthetic with peripheral nerve stimulation in the residual limb. 18

A systematic review of amputation surgical techniques demonstrated that Targeted Muscle Reinnervation (TMR) and Regenerative Peripheral Nerve Interface (RPNI) are effective at prevention of phantom limb pain development. 25 TMR is a surgical technique in which amputated nerves are transferred to nearby motor nerves for neuroma prevention has been shown to decrease both phantom limb pain and residual limb pain. 19 RPNI involves wrapping a transected nerve in an autologous muscle graft and placing it proximal to the surgical incision to prevent neuroma irritation. 25

Gaps in the Evidence-Based Knowledge

At present no evidence-based approach to the treatment of phantom pain exists. In a review of 186 research articles on phantom pain, it was found that only 12 were strong enough to be included, and out of the 12, only 3 were randomized controlled cross-over trials. 15  Great advances have been made in starting to understand the roles of the peripheral and central nervous system in phantom pain; however, a conclusive, unified pathophysiology remains elusive. Although various interventional and non-interventional treatments are currently used and show potential to reduce phantom pain, large randomized controlled trials are needed to evaluate the outcomes. Pharmacologic treatments, mostly based on the treatment of neuropathic pain, need further study.

  • Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet . 2006;367:1618-1625.
  • Dijkstra PU, Geertzen JH, Stewart R, van der Schans CP. Phantom pain and risk factors: a multivariate analysis. J Pain Sympt Manage . 2002;24(6):578-585.
  • Weiss SA and Lindell B. Phantom Limb Pain and Etiology of Amputation in Unilateral Lower Extremity Amputees.  Journal of Pain and Symptom Management .1996 Jan;11(1):3-17.
  • Devor M, Seltzer Z. Pathophysiology of damaged nerves in relation to chronic pain. In: Wall PD, Melzack R, eds. Wall and Melzack Textbook of Pain . 4th ed. Edinburgh, UK: Churchill Livingstone; 1999:129-164.
  • Maclver K, Lyoyd DM, Kelly S, Roberts N, Nurmikko T. Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery. Brain .2008;131(8):2181-2191.
  • Richardson C, Glenn S, Horgan M, Nurmikko T. A prospective study of factors associated with the presence of phantom limb pain six months after major lower limb amputation in patients with peripheral vascular disease. J Pain. 2007;8(10):793-801.
  • Purushothaman S, Kundra P, Senthilnathan M, Sistla SC, Kumar S. Assessment of efficiency of mirror therapy in preventing phantom limb pain in patients undergoing below-knee amputation surgery-a randomized clinical trial. J Anesth. 2023 Feb 21. doi: 10.1007/s00540-023-03173-9. Epub ahead of print. PMID: 36809505.
  • Kern U, Altkemper B, Kohl M. Management of phantom pain with a textile, electromagnetically-acting stump liner: a randomized, double-blind, crossover study. J Pain Sympt Manage . 2006;32(4):352-360.
  • Maier C, Dertwinkel R, Mansourian N. Efficacy of the NMDA-receptor antagonist memantine in patients with chronic phantom limb pain: results of a randomized double-blinded, placebo-controlled trial. Pain . 2003;103:277-283.
  • Erlenwein J, Diers M, Ernst J, Schulz F, Petzke F. Clinical updates on phantom limb pain. Pain Rep. 2021 Jan 15;6(1):e888. doi: 10.1097/PR9.0000000000000888. PMID: 33490849; PMCID: PMC7813551.
  • Knotkova H, Cruiciani R, Tronnier V, Rasche D. Current and future options for management of phantom-limb Pain. Current and future options for management of phantom-limb Pain . JPR. 2012:39. Doi:10.214/jpr.s16733
  • Rayner HC, Atkins RC, Westerman RA. Relief of local stump pain by capsaicin cream. Lancet 1989; 2: 1276–7.
  • Krouskop, T. A pulsed Doppler ultrasonic system for making noninvasive measurements of the mechanical properties of soft tissue. Available at:
  • Pereira E. Thalamic deep brain stimulation for neuropathic pain after amputation or brachial plexus avulsion. National Center for Biotechnology Information . Available at:
  • Halbert J, Crotty M, Cameron ID. Evidence for optimal management of acute and chronic phantom pain: a systematic review. Clin J Pain . 2002;18:84-92. 
  • Larbig W, Andoh J, Huse E, Stahl-Corino D, Montoya P, Seltzer Z, Flor H. Pre- and Postoperative Predictors of Phantom Limb Pain. Neuroscience Letters . 2019; 702:44-50.
  • Osumi M, Inomata K, Inoue Y, Otake Y, Morioka S, Sumitani M. Characteristics of Phantom Limb Pain Alleviated with Virtual Reality Rehabilitation. Pain Medicine . 2019; 20(5):1038-1046.
  • Petersen B, Nanivadekar A, Chandrasekaran S, Fisher L. Phantom Limb Pain: Peripheral Neuromodulatory and Neuroprosthetic Approaches to Treatment. Muscle & Nerve . 2019; 59(2):154-167
  • Valerio I, Dumanian G, Jordan S, Mioton L, Bowen J, West J, Porter K, Ko J, Souza J, Potter B. Preemptive Treatment of Phantom and Residual Limb Pain with Targeted Muscle Reinnervation at the Time of Major Limb Amputation. Journal of the American College of Surgeons . 2019; 228(3):217-226.
  • Desmond DM, 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.
  • Ehde DM, Czerniecki JM, Smith DG, Campbell KM, Edwards WT, Jensen MP, Robinson LR. Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation.  Arch Phys Med Rehabil  2000;81:1039–44.
  • Flor H. Phantom-limb pain: characteristics, causes, and treatment.  Lancet Neurol  2002;1:182–9.
  • Alviar MJ, Hale T, Dungca M. Pharmacologic interventions for treating phantom limb pain.  Cochrane Database Syst Rev  2016:CD006380. 
  • Gilmore C., Ilfeld B., Rosenow J., Li S., Desai M., Hunter C., Rauck R., Kapural L., Nader A., Mak J., et al. Percutaneous peripheral nerve stimulation for the treatment of chronic neuropathic postamputation pain: A multicenter, randomized, placebo-controlled trial.  Reg. Anesth. Pain Med.  2019;44:637–645. doi: 10.1136/rapm-2018-100109. 
  • J.W.D. de Lange, C.A. Hundepool, D.M. Power, V. Rajaratnam, L.S. Duraku, J.M. Zuidam, Prevention is better than cure: Surgical methods for neuropathic pain prevention following amputation – A systematic review, Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 75, Issue 3, 2022, Pages 948-959, ISSN 1748-6815, (

Original Version of the Topic:

Matthew Medwick, MD. Phantom Pain. Publication Date: 11/11/2011.

Previous Revision(s) of the Topic

David Haustein, MD, Preeti Panchang, MD. Phantom Pain. 4/19/2016

Matthew Adamkin, MD. Phantom Pain. 4/19/2016

Author Disclosure

Matthew Adamkin, MD Nothing to Disclose

David Levin, DO Nothing to Disclose

Katrina Slater, DO Nothing to Disclose

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Phantom limb related phenomena and their rehabilitation after lower limb amputation


  • 1 Department of Clinical Neurophysiology, Foundation S. Maugeri IRCCS, Scientific Institute of Montescano, Montescano, Italy. [email protected]
  • PMID: 20032915

This paper reviewed the various hypotheses on phantom limb and phantom limb pain as well as all the related rehabilitation techniques to control these symptoms. The uncertainty in their pathophysiology strongly affects all the rehabilitation approaches so far used, as no single parameter has been found to predict or control phantom limb pain as well as no single factor can be quoted as an indicator of rehabilitation success for lower limb amputation. Within a comprehensive rehabilitation plan, behavioral interventions, stimulation techniques, feedback, physical therapies designed to possibly reverse the maladaptive memory traces and enhance its extinction have been described. Although substantially not clinically useful, pharmacological and surgical interventions also have been briefly considered. A reassessment of the actual strategies used is suggested with a role for rehabilitation not only after the amputation but also in the pre-emptive control of the pre-existing painful condition. In this process, rehabilitation should take into account many parameters, not always related to the traditional role of rehabilitation. Pain assessment before and after amputation, its natural history and clinical picture such as its quality, variations, level of the amputation, dominance, time interval between amputation and rehabilitation, as well as all the other phantom limb related phenomena should be considered and treated.

Publication types

  • Amputation, Surgical / adverse effects
  • Amputation, Traumatic / complications
  • Amputation, Traumatic / physiopathology
  • Amputation, Traumatic / rehabilitation
  • Lower Extremity*
  • Phantom Limb / etiology
  • Phantom Limb / physiopathology
  • Phantom Limb / rehabilitation*

Virtual Reality to Treat Phantom Limb Pain

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  • Virtual Reality for Phantom Limb Pain

Intuitively Controlled Virtual Reality System to Treat Phantom Limb Pain

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A Virtual Reality System to Treat Phantom Limb Pain

Limb loss can cause chronic pain, including the formation of painful neuromas and  phantom limb pain (PLP) where ongoing painful sensations in the area of the missing limb can persist. While any type of pain can be debilitating, the exact mechanisms of PLP are less understood, and as a result, current treatment options are limited and have been mostly ineffective.

Some recent research suggests that targeted muscle reinnervation , a surgical nerve transfer procedure, can prevent neuroma formation and PLP in some amputees if performed at the time of amputation. In addition, noninvasive and non-pharmacological forms of treatment, such as mirror therapy ,  has shown some promise for reducing PLP. However, one disadvantage of mirror therapy is that it is unclear if the user is intending to execute the motor commands with their phantom limb, or if they are just watching the image of their intact limb move. Advancements in pattern recognition systems that can decipher electromyographic (EMG) signal patterns generated by the residual limb muscles invites new opportunities to enhance treatment of PLP beyond basic mirror therapy.

Recent studies suggest that using pattern recognition to control a virtual limb may have similar therapeutic benefits. The Shirley Ryan AbilityLab recently developed a virtual reality-based (VR), rehabilitation system for individuals with upper limb amputation which consists of:

  • A gel-liner system with embedded electrodes for EMG signal acquisition
  • A Coapt, LLC Gen 2 pattern recognition system
  • A virtual gaming software for 2D or 3D rendering

In previous work, we showed that the VR system can be used as a rehabilitation training device to improve prosthetic control , as well as provided encouraging evidence of its multi-functional utility in providing relief from PLP.

Goals and Hypothesis

Virtual Reality System

This project builds upon our prior work to further test our VR system for individuals with lower limb amputation and to evaluate its potential for PLP therapy in a larger trial. We will develop a commercially viable VR rehabilitation system (called the Coapt PLP Management System) which can be deployed at home or in-clinic for individuals with upper or lower limb amputations. Our hypothesis is that long-term use of the VR system will significantly reduce PLP.

Lead Study Personnel

Levi Hargrove, PhD, Co-Principal Investigator

Blair Lock, CEO, Coapt, Co-Principal Investigator

Mentioned Profile

Levi Hargrove, PhD

Levi Hargrove, PhD

Related publications & patents.

Hargrove LJ, Woodward RB, inventors; Rehabilitation Institute of Chicago, assignee. Prosthetic virtual reality training interface and related methods . United States patent US 10,796,599. 2020 Oct 6.

Woodward RB, Hargrove LJ. Adapting myoelectric control in real-time using a virtual environment . Journal of neuroengineering and rehabilitation. 2019 Dec 1;16(1):11.

Funding Source

Restoring Warfighters with Neuromusculoskeletal Injuries Research Award (RESTORE), Department of Defense

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phantom limb pain rehabilitation

  • Ekaterina Pechenkova Institute of Practical Psychology and Psychoanalysis, Moscow, Russia Radiology Department, Federal Center of Treatment and Rehabilitation, Moscow, Russia
  • Maria Kuvaldina Saint-Petersburg State University, Saint-Petersburg, Russia
  • Liudmila Litvinova Radiology Department, Federal Center of Treatment and Rehabilitation, Moscow, Russia
  • Alena Rumshiskaya Radiology Department, Federal Center of Treatment and Rehabilitation, Moscow, Russia
  • Polina Iamshchinina Vrij University of Amsterdam, Amsterdam, Netherlands
  • Valentin Sinitsyn Radiology Department, Federal Center of Treatment and Rehabilitation, Moscow, Russia
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Ekaterina Pechenkova , Maria Kuvaldina , Liudmila Litvinova , Alena Rumshiskaya , Polina Iamshchinina , Valentin Sinitsyn; Looking for neural correlates of sustained inattentional blindness with single trial per subject design in fMRI. Journal of Vision 2015;15(12):447. .

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An inability to notice an extra salient item once the attention is engaged in some other task, called Inattentional Blindness (IB; Mack & Rock, 1998), is widely used in research on visual awareness. However, the neuroimaging of IB is limited due to technical issues, including the possible number of trials per subject. Since the IB decreases once the participant is informed about the effect, a single trial per subject design is usually implemented in psychophysics. FMRI studies of IB so far have either substantially changed the original paradigm (Thakral, 2011) or didn’t measure the IB effect while scanning (Todd et al., 2005; Matsuyoshi, Ikeda, 2010). Our research aimed at investigating the neural correlates of IB in multiple object tracking (MOT) task preserving the design of a single trial. In the scanner participants traced eight moving white and black circles and counted bounces of the white circles off the edges of the screen. In experimental group an extra item (a dark grey square) traveled across the screen for 7 seconds. It was neither verbally reported nor recognized by 69% of 23 observers (the IB effect). BOLD signal evoked by the unnoticed stimulus in 16 IB subjects was compared with the signal in 16 control subjects who were not presented with an extra item. Greater activation (p< 0.001 uncorrected, k=3 voxels) was found in both left and right FEF in the control condition. Separate analysis of the activation in experimental and control group demonstrated clear and significant (p< 0.05 FWE corrected) neural signature of the MOT task (Howe et al., 2009; Culham et al., 2001) including the bilateral V5, IPS, SPL and PMA/FEF areas. Thus our results advocate the feasibility of a single trial per subject design in fMRI and its potential use for research on the unconscious information processing in IB.

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Re: samuimw, moscow dr.bagirov, goodlucktomylegs.

I'm staying in the clinic for 15 days after I will fly back to my country. Price for fifteen days is 1130 Euro, it's expensive because it includes surgical treatment and rehabilitations for 15 days too.


yeah 1.5mm a day is far too much. i am planning on 5cm, if i do 0.66 a day, would that be 76 days to finish, so in total 7 weeks of lengthening, would you agree with this? id love to be done sooner and quicker with 5cm,maybe you will do more, we will see what happens as we are both the same height. also how do you plan to clean pin sites, yourself or local doctors?
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  1. Mirror Therapy Needs Time to Work in Severe Phantom Pain

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  2. Optimizing Rehabilitation for Phantom Limb Pain Using Mirror Therapy

    phantom limb pain rehabilitation

  3. Phantom Limb Pain

    phantom limb pain rehabilitation

  4. Treatments for Phantom Limb Pain

    phantom limb pain rehabilitation

  5. Virtual Reality: A Promising Frontier in Phantom Pain Therapy

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  6. Phantom Limb Pain

    phantom limb pain rehabilitation


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  1. Phantom Limb Pain: Mechanisms and Treatment Approaches

    Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain. Go to: 1.

  2. An Algorithm Approach to Phantom Limb Pain

    Phantom limb pain (PLP) is a common condition that occurs following both upper and lower limb amputation. First recognized and described in 1551 by Ambroise Pare, research into its underlying pathology and effective treatments remains a very active and growing field. ... rehabilitation specialist, anesthesiologist, and psychologist. A ...

  3. Phantom Limb Pain: What is It, Causes, Treatment & Outcome

    Pain relievers and a treatment called mirror therapy can ease phantom pain. What is phantom limb pain? After an amputation, some people experience pain in the part of the limb that's no longer there. This sensation is phantom limb pain. The pain is real.

  4. Phantom Limb Pain

    Onset Onset is mostly immediate after amputation, some at a few weeks, rarely months later. A US study has found that for 3 to 4% percentage of individuals with amputation, onset of PLP occurred more than a year after amputation. [4]

  5. Physical Therapy Guide to Phantom Limb Pain

    Physical therapists use a variety of treatment options to help people with phantom limb pain. Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation.

  6. PDF Phantom Pain

    Rehab Management: Physical therapy is an important part of phantom pain management. Also important are proper stump care and prosthetic limb fit which can be coordinated between a PM&R physician and the person who makes the prosthetic limb.

  7. Effectiveness of Mirror Therapy for Phantom Limb Pain: A Systematic

    Effectiveness of Mirror Therapy for Phantom Limb Pain: A Systematic Review and Meta-analysis - Archives of Physical Medicine and Rehabilitation Effectiveness of Mirror Therapy for Phantom Limb Pain: A Systematic Review and Meta-analysis Hui-Min Xie, MD Ke-Xue Zhang, PhD * Shuo Wang, MD * Na Wang, BS Xia Li, BS Li-Ping Huang, PhD Show all authors

  8. Phantom-limb pain: characteristics, causes, and treatment

    Phantom-limb pain is a common sequela of amputation, occurring in up to 80% of people who undergo the procedure. It must be differentiated from non-painful phantom phenomena, residual-limb pain, and non-painful residual-limb phenomena. Central changes seem to be a major determinant of phantom-limb pain; however, peripheral and psychological factors may contribute to it. A comprehensive model ...

  9. Mind-Body Interventions for Treatment of Phantom Limb Pain in Persons

    Phantom limb pain (PLP) is a significant source of chronic pain in most persons with amputation at some time in their clinical course. Pharmacologic therapies for this condition are often only moderately effective and may produce unwanted adverse effects.

  10. Unveiling the phantom: What neuroimaging has taught us about phantom

    1. INTRODUCTION Pain is unique to individuals who experience it, and the subjective nature of pain challenges its fundamental understanding. Phantom limb pain (PLP) is one such clinical mystery for researchers, clinicians, and patients.

  11. Non-surgical Management of Phantom Limb Pain: Current and ...

    Current Physical Medicine and Rehabilitation Reports Article Non-surgical Management of Phantom Limb Pain: Current and Emerging Clinical Approaches Published: 28 February 2023 Volume 11 , pages 16-24, ( 2023 ) Cite this article Download PDF Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript Amy L. de Jongh Curry,

  12. Immersive Low-Cost Virtual Reality Treatment for Phantom Limb Pain

    A significant proportion of individuals who experience a PL—from 65 to 70% in many studies—also experience persistent and debilitating pain in the missing limb, a condition known as phantom limb pain (PLP) ( 2, 3 ).

  13. 5 Ways to Deal With Phantom Limb Pain After Amputation

    Local injection therapy: The physician injects a local pain-blocking agent at the amputation site. This can calm the painful signals sent by the nerve endings to the brain. Non-opiate analgesic ...

  14. Treatment Strategies and Effective Management of Phantom Limb ...

    PMID: 31359171 DOI: 10.1007/s11916-019-0802- Abstract Purpose of review: Phantom sensations are incompletely understood phenomena which take place following an amputation or deafferentation of a limb. They can present as kinetic, kinesthetic, or exteroceptive perceptions.

  15. Managing Phantom Pain

    Phantom limb pain (PLP) refers to ongoing painful sensations that seem to be coming from the part of the limb that is no longer there. The limb is gone, but the pain is real. The onset of this pain most often occurs soon after surgery. It can feel like a variety of things, such as burning, twisting, itching or pressure.

  16. Phantom Pain

    Condition: Phantom pain is the feeling of pain in an organ or limb that is not physically present. Background: Phantom pain occurs exclusively after limb amputation or after removal of organs, such as breast, eye, penis, or tongue. Approximately 60-80% of patients experience phantom pain within the first week after amputation, and this pain ...

  17. Phantom Pain

    Definition Phantom pain is a noxious sensory perception of pain in an organ or limb that is physically not present. Stump pain is pain localized in the residual limb, and phantom sensation is the non-painful sensation of the presence of a missing limb. Etiology

  18. Phantom limb related phenomena and their rehabilitation after lower

    Pain assessment before and after amputation, its natural history and clinical picture such as its quality, variations, level of the amputation, dominance, time interval between amputation and rehabilitation, as well as all the other phantom limb related phenomena should be considered and treated. Amputation, Surgical / adverse effects.

  19. Intuitively Controlled Virtual Reality System to Treat Phantom Limb Pain

    A Virtual Reality System to Treat Phantom Limb Pain. Limb loss can cause chronic pain, including the formation of painful neuromas and phantom limb pain (PLP) where ongoing painful sensations in the area of the missing limb can persist. While any type of pain can be debilitating, the exact mechanisms of PLP are less understood, and as a result ...

  20. Moscow Based Company Introduces Exoskeleton for People With Lower Limb

    With the help of this advanced exoskeleton, patients will be able to walk again, go up and down the stairs, sit down and stand up all by themselves.

  21. Epos™

    Intraabdominal adhesions are nonspecific but important long-term complications seen after open or laparoscopic surgery.[1,2] Adhesions develop in approximately 93% of patients undergoing major abdominal or pelvic surgery.[3]Recently, the detection of visceral sliding on functional cine magnetic resonance imaging has been introduced as an accurate, reliable, and noninvasive tool for identifying ...

  22. Looking for neural correlates of sustained inattentional ...

    Institute of Practical Psychology and Psychoanalysis, Moscow, Russia Radiology Department, Federal Center of Treatment and Rehabilitation, Moscow, Russia Maria Kuvaldina Saint-Petersburg State University, Saint-Petersburg, Russia

  23. Samuimw, Moscow Dr.Bagirov

    Limb Lengthening Patients Experiences > Samuimw, Moscow Dr.Bagirov « previous next ...