Pain Centre

Updated 03 April 2017

The mysterious pain in a body part that doesn’t exist

Doctors aren’t certain about the exact cause of 'phantom pain', but it appears to originate in the spinal cord and brain.

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He started to feel a sharp pain in his left ankle. At first Christo Schoonraad*, an accountant from Durbanville in Cape Town, didn’t think much of it, but the pain persisted. “It was a shooting, throbbing pain. Sometimes an itchiness or tingling sensation would accompany it.”

For any other person this pain would be uncomfortable, but not too worrisome. But in Schoonraad’s case it was just plain mysterious. That’s because he had his left leg amputated a week before the pain started. He suffers from a condition known as “phantom limb”.

A real sensation

Phantom pain is pain that feels like it's coming from a body part that's no longer there.

A previous Health24 article stated that amputees feel at least some sensations in the missing limb. At first, the phantom limb feels intact, even movable. While a few lucky patients merely feel mild tingling or sensations of heat or cold, 60–80% of amputees suffer actual pain.

“At first I thought it was the weirdest feeling ever and that I was going mad, but my doctor told me there was a perfectly good explanation.”

Research published in  The New England Journal of Medicine shows that doctors themselves used to think it was psychological in nature. 

Phantom limb pain sometimes mimics the pain that afflicted the limb before it was amputated. In other cases, it creates new agony, unlike anything a person has ever felt before.

Schoonraad’s leg was amputated after a car accident, but he didn’t feel pain. “I was immediately taken to the operating room and was unconscious.”  

Some common symptoms include:

  • Onset of sensations within the first few days of amputation
  • Shooting, stabbing, throbbing or burning pain
  • Pain in the part furthest away from the centre of the body 

One explanation might be that the pain “may be induced by a conflict between visual feedback and proprioceptive representations of the amputated limb”.

Doctors aren’t certain about the exact causes, but it appears to originate in the spinal cord and brain. The parts of the brain that has been connected to the limb via neural pathways, receives mixed signals. After an amputation the body is trying to understand the loss, and the most basic message that it will send is pain.

Treatment

At this time, there is no single treatment for phantom limb pain. Treatment is often a case of trial and error and can include medications that calm nerves, anti-seizure drugs and painkillers such as opioids.  

Mirror therapy works by having patients watch themselves move the intact limb in a mirror, and positioning the mirror in such a way as to give the appearance that the missing limb is still intact.  

“For now it seems the painkillers are working,” says Schoonraad. In the meantime experts are still investigating conclusive/successful treatment options.

*Not his real name. 

Read more: 

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Penis amputation instead of circumcision

Diabetes: foot amputation avoidable