What is phantom limb pain? 5 questions, answered

Amputation surgeries are sometimes used to treat cancer that affects an extremity, including toes, fingers, legs and arms. When a limb is removed from the body, it can be difficult for the brain and nervous system to readjust after the loss. 

“The brain will send signals out to try to find the missing appendage and it won’t get signals back, which can lead to pain for amputees,” explains plastic surgeon Margaret Roubaud, M.D. 

This sensation is referred to as phantom limb pain. It can impact up to 80% of people who have an amputation.   

Here, Roubaud answers questions about phantom limb pain and shares how she and a team at MD Anderson are using an innovative surgical technique to bring pain relief to amputees. 

What is phantom limb pain? 

Most people will have a phantom sensation immediately after an amputation, explains Roubaud. It can feel like the limb is still there. But if the sensations remain after three to six months, they can become painful and distressing.  

“Phantom limb pain can feel like a burning, stabbing or electrical feeling. We think it’s an interplay between the brain and other factors in the environment that can set this off,” she says.  

How is it diagnosed? 

There is no diagnostic test for phantom limb pain. We can only identify it based on what patients tell us about the pain they’re experiencing.  

Can phantom limb pain be treated? 

Roubaud and a team at MD Anderson, including orthopaedic oncologist Valerae Lewis, M.D., and Keyuri Popat, M.D., have introduced an innovative surgical technique to reduce, or even eliminate, phantom limb pain. 

“When an amputation is complete, a plastic surgeon creates a ‘buddy system’ between the amputated nerves and a nearby nerve or piece of muscle,” Roubaud explains. “By doing this, the nerve makes new connections with its ‘buddy,’ and the brain stops looking for the missing limb.” 

The procedure is most effective when it’s done at the time of amputation, but it can be done after, for up to 10 years after the amputation. Patients usually start to note a reduction in pain within six to eight weeks. 

“This is a multidisciplinary effort, and we have a very collaborative relationship with our pain management team, physical therapists and occupational therapists to provide the best outcomes for patients,” Roubaud says.  

Are there any risks or side effects to this procedure? 

“There is no evidence to suggest that this procedure makes pain any worse,” she says. “The biggest side effect is it may not be as effective for some people as it is for others. Nothing is perfect, but we believe we can make things dramatically better.” 

Why come to MD Anderson for phantom limb pain treatment? 

“Our team has made this procedure the new gold standard for amputation, whenever possible,” she says. “We are ushering in a new stage of what it means to be an amputee.” 

For Roubaud and her team, reducing pain is important to getting patients back to living their lives. If patients aren’t in pain, they are more likely to put on their prosthetic and more likely to use it.  

“Another benefit is significantly reducing narcotic use among these patients, which can promote more effective rehabilitation and psychosocial benefits,” she says. 

Roubaud shares that while there has been progress made with antibiotics and anesthesia, this is the first big surgical change in over 100 years regarding amputations. 

“The goal of treating cancer is not just to survive it, but to thrive,” she says. “And having less pain is a huge part of that.”  

Request an appointment at MD Anderson online or call 1-877-632-6789.