Many individuals who have undergone an amputation experience phantom limb sensation, a feeling that the missing limb is still present. Symptoms can include persistent aching, cramping, stabbing pain, burning sensations, and tingling or itching perceived to originate from the amputated area. Some patients also report feeling as though their missing limb is stuck in an uncomfortable position.
“Phantom limb sensation is common and expected after amputation,” said Christopher Alessia, D.O., a specialist in physical medicine and rehabilitation at the University of Miami Health System. “Phantom limb pain (PLP), also common, is defined by its discomfort and is something we can treat.”
Dr. Alessia and other specialists at UHealth’s Total Limb Care clinic provide various treatments for phantom limb sensation and pain with the aim of improving patient quality of life.
The cause of phantom limb pain is believed to be related to changes in the brain’s somatosensory and motor areas following amputation. The brain maintains a map of the body that allows people to move without looking directly at their limbs. After amputation, this map may become distorted.
“Because of the loss of the body part in amputation, the boundaries of this map in the brain that were once clear become less distinct,” said Natalia Fullerton, M.D., an orthopedic and plastic hand surgeon with UHealth’s Total Limb Care clinic. “As a result, the body feels pain in a location that is no longer physically there.”
The absence of feedback from nerves previously connected to the lost limb can contribute to these sensations. Factors such as stress, weather changes, or poorly fitting prosthetics may trigger nerve pain.
Treatment options are diverse and tailored for each patient. “The benefit of the Total Limb Care clinic is that we’re able to expand the multidisciplinary therapies we can offer because we have so many options and the breadth of knowledge we have access to,” Dr. Fullerton explained. “Each patient is different in terms of experience and degree of their pain, as well as therapies they’ve already tried. Depending on each patient’s current situation, we are able to tailor what we offer.”
Dr. Alessia added: “UHealth’s physical medicine and rehabilitation specialists, prosthetists, and plastic surgeons work together to address prosthetic concerns, skin issues, pain, and limb reconstruction. For many of our patients, PM&R [physical medicine & rehabilitation], plastic surgeons, and orthopedics all play a role in their care; coordination happens in one clinic visit.”
“We take a tiered approach to treatment that includes pharmacologic, non-pharmacologic, and interventional therapies,” he continued. “We focus on non-pharmacologic interventions which have the best research literature in support of their efficacy.” However, combinations are often used throughout a patient’s lifetime.
Desensitization techniques such as massage or exposure to different textures can help reduce discomfort associated with phantom limb syndrome. Transcutaneous electrical nerve stimulation (TENS) units deliver mild electrical pulses through pads placed on skin near painful areas—these pulses block some pain signals or stimulate natural release of endorphins.
Physical therapy exercises including left/right discrimination tasks or strengthening muscles important for using prostheses may indirectly alleviate phantom pain. Other approaches include guided motor imagery—patients imagine moving their missing limbs—and mirror therapy where visual illusions help retrain brain perception.
Virtual reality devices are also being explored for therapy: “We are working with engineering students at UM who have developed an augmented reality (AR) program specifically for amputees,” Dr. Fullerton noted. “With AR glasses our patients can see their missing limb and have reported significant improvement in their PLP.”
Mental health support forms another component: cognitive behavioral therapy (CBT) helps reframe negative thoughts about pain; eye movement desensitization reprocessing (EMDR) addresses distressing memories; hypnosis may disrupt feedback loops linked with painful sensations; support groups provide community resources for coping strategies.
Medication options include gabapentin or pregabalin (anticonvulsants), serotonin-norepinephrine reuptake inhibitors or tricyclic antidepressants (for chronic nerve pain), as well as opioids when necessary under specialist supervision.
Interventional procedures involve targeted muscle reinnervation—a surgery redirecting nerves into healthy muscles—to manage neuromas or improve prosthesis control; steroids may be injected around neuromas; neuromodulation uses electrical impulses or medication targeting nerves responsible for persistent discomfort.
Measuring PLP remains challenging due to lack of specific tools: “There are generalized pain scales… but these are not specific to PLP,” Dr. Fullerton said.” Given this limitation… one of our main research goals as an amputation team is to create a questionnaire that can accurately measure each patient’s experience.” Development efforts are underway on such assessment tools at UHealth.
