315:
264:. One theory is it may be related to central sensitization, which is a common experience among amputees. Central sensitization is when there are changes in the responsiveness of the neurons in the dorsal horn of the spinal cord, which deals with processing somatosensory information, due to increased activity from the peripheral nociceptors. Peripheral nociceptors are sensory neurons that alert us to potentially damaging stimuli.
180:
missing limb. Later brain scans of amputees showed the same kind of cortical reorganization that Pons had observed in monkeys. Ramachandran have also performed the world's first phantom limb amputation surgeries by asking patients to visualize the missing limb, which relieved pain, and in the long term completely removed the sensation of a phantom limb – the method is now known as the
207:
with PLS can be experienced in the entire limb or just one portion of the missing limb. Phantom limb can also present itself in two ways: phantom limb pain or phantom limb sensations. Phantom limb pain is a painful or unpleasant sensation experienced where the amputated limb was. Phantom sensations are any other, nonpainful sensations perceived in the amputated or missing limb area.
140:
amplified due to the missing limb; therefore, the patient may experience the overflow of information as pain. The patient contains repressed memories from previous motor commands of clenching the hand and sensory information from digging their nails into their palm. These memories remain due to previous neural connections in the brain.
356:
in the early 1990s, little research was done on it before 2009, and much of the subsequent research has been of poor quality, according to a 2016 review. A 2018 review, which also criticized the scientific quality of many reports on mirror therapy (MT), found 15 good-quality studies conducted between
267:
There are theories that the phantom limb phenomenon may relate to reorganization of the somatosensory cortex after the limb is removed. When the body receives tactile input near the residual limb, the brain is convinced that the sensory input was received from the amputated limb because another brain
206:
Phantom limb syndrome (PLS) is a sensation that the amputated or missing limb is still attached to the body. This is different from residual limb pain (RLP) that is often experienced by people with amputations. While RLP occurs in the remaining or residual body part, the pain or sensation associated
139:
Repressed memories in phantom limbs could potentially explain the reason for existing sensations after amputation. Specifically, there have been several reports from patients of painful clenching spasms in the phantom hand with the feeling of their nails digging into their palms. The motor output is
103:
is still attached. It is a chronic condition which is often resistant to treatment. When the cut ends of sensory fibres are stimulated during thigh movements, the patient feels as if the sensation is arising from the non-existent limb. Sometimes the patient might feel pain in the non-existent limb.
215:
There are 3 differentiated types of phantom sensations: kinetic, kinesthetic, and exteroceptive. Kinetic phantom sensations are perceived movements of the amputated body part (i.e., feeling your toes flex). Kinesthetic phantom sensations are related to the size, shape, or position of the amputated
1052:
It is unsurprising that with an amputation that such an intricate highway of information transport to and from the periphery may have the potential for problematic neurologic developments...Although phantom limb sensation has already been described and proposed by French military surgeon
Ambroise
179:
hypothesized that phantom limb sensations in humans could be due to reorganization in the human brain's somatosensory cortex. Ramachandran and colleagues illustrated this hypothesis by showing that stroking different parts of the face led to perceptions of being touched on different parts of the
999:
Currently, the most commonly posited CNS theory is the cortical remapping theory (CRT), in which the brain is believed to respond to limb loss by reorganizing somatosensory maps (16)... While an amputation directly affects the PNS, the CNS is also affected due to changes in sensory and movement
164:
had recognized that the peripheral neuroma account could not be correct, because many people born without limbs also experienced phantom limbs. According to
Melzack the experience of the body is created by a wide network of interconnecting neural structures, which he called the "neuromatrix".
156:, in the sixteenth century. Pare noticed that some of his patients continued reporting pain in the removed limb after he performed the amputation. For many years, the dominant hypothesis for the cause of phantom limbs was irritation in the peripheral nervous system at the amputation site (
1713:
It is a valid, simple, and inexpensive treatment for PLP. The methodological quality of most publications in this field is very limited, highlighting the need for additional, high-quality studies to develop clinical protocols that could maximise the benefits of MT for patients with
136:. Exposure to extreme weather conditions, especially below freezing temperatures, can cause increased sensitivity to the sensation. Phantom limb pain is usually intermittent, but can be continuous in some cases. The frequency and intensity of attacks usually declines with time.
216:
body part (i.e., feeling as if your hand is in a twisted position). Exteroceptive phantom sensations are related to sensations perceived to be felt by the amputated body part (i.e., feelings of touch, pressure, tingling, temperature, itch, and vibrations).
123:
People will sometimes feel as if they are gesturing, feel itches, twitch, or even try to pick things up. The missing limb often feels shorter and may feel as if it is in a distorted and painful position. Occasionally, the pain can be made worse by
256:. Somatotopic representation seems to be a factor in the experience of phantom limb, with larger regions in the sensory homunculus typically experiencing more phantom sensations or pain. These areas include the hands, feet, fingers and toes.
59:
2149:
2130:
112:). These sensations are relatively common in amputees and usually resolve within two to three years without treatment. Research continues to explore the underlying mechanisms of phantom limb pain (PLP) and effective treatment options.
271:
Phantom sensations can also occur when there has been a peripheral nerve injury resulting in deafferentation. This causes changes in the dorsal horn of the spinal cord, which normally has an inhibitory effect on sensory transmission.
357:
2012 and 2017 (out of a pool of 115 publications), and concluded that "MT seems to be effective in relieving PLP, reducing the intensity and duration of daily pain episodes. It is a valid, simple, and inexpensive treatment for PLP."
259:
In phantom limb syndrome, there is sensory input indicating pain from a part of the body that is no longer existent. This phenomenon is still not fully understood, but it is hypothesized that it is caused by activation of the
268:
region took over. Reorganization has been thought to be related to sensory-discriminative parts of pain as well as the affective-emotional parts of it (I.e., insula, the anterior cingulate cortex, and the frontal cortices).
219:
An additional sensation that some people with amputations experience is known as telescoping. Telescoping is when you feel as if your amputated limb is becoming more proximal to your body through progressive shortening.
65:
63:
60:
64:
376:
Phantom sensations have been noted in the transgender population. Some people who have undergone sex reassignment surgery (SRS) have reported the sensation of phantom genitals. The reports were less common among
194:
Despite a great deal of research on the underlying neural mechanisms of phantom limb pain there is still no clear consensus as to its cause. Both the brain and the peripheral nervous system may be involved.
62:
120:
Most (80–100%) amputees experience a phantom limb, with some of them having non-painful sensations. The amputee may feel very strongly that the phantom limb is still part of the body.
388:. Phantom penises in pre-SRS transgender men have been documented to be similar to the rate of phantom sensations in cis men post-penectomy. Similarly, subjects who had undergone
349:. The mirror box provides a reflection of the intact hand or limb that allows the patient to "move" the phantom limb, and to unclench it from potentially painful positions.
152:, there have been earlier reports of the phenomenon. One of the first known medical descriptions of the phantom limb phenomenon was written by a French military surgeon,
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1607:
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1948:
Hanyu-Deutmeyer AA, Cascella M, Varacallo M. Phantom Limb Pain. 2023 Aug 4. In: StatPearls . Treasure Island (FL): StatPearls
Publishing; 2024 Jan–. PMID: 28846343.
191:(Oxford) and Marshall Devor (Hebrew University, Jerusalem) argue that phantom limb pain is primarily the result of "junk" inputs from the peripheral nervous system.
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61:
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2194:
509:
1180:
Willoch, Frode; Rosen, Gunnar; Tolle, Thomas Rudolf; Oye, Ivar; Wester, Hans Jurgen; Berner, Niels; Schwaiger, Markus; Bartenstein, Peter (December 2000).
1235:
Foell, Jens; Bekrater-Bodmann, Robin; Flor, Herta; Cole, Jonathan (December 2011). "Phantom Limb Pain After Lower Limb Trauma: Origins and
Treatments".
810:
Pons TP, Garraghty PE, Ommaya AK, Kaas JH, Taub E, Mishkin M (1991). "Massive cortical reorganization after sensory deafferentation in adult macaques".
1816:
Sörös, P.; Vo, O.; Husstedt, I.-W.; Evers, S.; Gerding, H. (2003). "Phantom eye syndrome: Its prevalence, phenomenology, and putative mechanisms".
2058:
927:
487:
450:
172:(NIH) showed that the primary somatosensory cortex in macaque monkeys undergoes substantial reorganization after the loss of sensory input.
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Most approaches to treatment over the past two decades have not shown consistent symptom improvement. Treatment approaches have included
2041:
Murray, C. (2009), "Developing an
Interdisciplinary Perspective on Amputation, Prosthesis Use, and Phantom Limb Pain: An Introduction",
772:
1182:"Phantom limb pain in the human brain: Unraveling neural circuitries of phantom limb sensations using positron emission tomography"
1859:
Andreotti, A. M.; Goiato, M. C.; Pellizzer, E. P.; Pesqueira, A. A.; Guiotti, A. M.; Gennari-Filho, H.; dos Santos, D. M. (2014).
1336:
1937:
1728:"Prevalence of phantom breast pain and sensation among postmastectomy patients suffering from breast cancer: a prospective study"
1449:"Systematic Review and Meta-analysis of the Efficacy of Perineural Local Anaesthetic Catheters after Major Lower Limb Amputation"
1181:
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experience sensations in their amputated limb. However, only a small percentage will experience painful phantom limb sensation (
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149:
1197:
421:
169:
39:
2005:
393:
378:
240:, spinomesencefalic tract), with pain and temperature information transferred via lateral spinothalamic tracts to the
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signaling. Debate still remains over the cause and maintaining factors of both phantom limbs and the associated pain.
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Phantom sensations may also occur after the removal of body parts other than the limbs, e.g. after amputation of the
410:
2067:
1911:
532:
466:
Manchikanti, Laxmaiah; Singh, Vijay; Boswell, Mark V. (2007-01-01), Waldman, Steven D.; Bloch, Joseph I. (eds.),
176:
1932:
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Maladaptive changes in the cortex may account for some but not all phantom limb pain. Pain researchers such as
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2225:
1965:
1410:
330:
may be useful around the time of surgery. Morphine may be helpful for longer periods of time. Evidence for
1623:"The effects of mirror therapy on pain and motor control of phantom limb in amputees: A systematic review"
342:
agents have poor evidence of success when placed after surgery in an effort to prevent phantom limb pain.
241:
229:
335:
1960:
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1601:
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73:
A cat attempting to use its left foreleg to scoop litter several months after it has been amputated
32:
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650:"Consciousness and body image: lessons from phantom limbs, Capgras syndrome and pain asymbolia"
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reported experiencing phantom breasts; these reports were substantially less common among post-
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2054:
2022:
1992:
1892:
1833:
1798:
1749:
1704:
1655:"The level of evidence is insufficient to recommend MT as a first intention treatment for PLP"
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576:
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339:
296:
153:
311:. Reliable evidence is lacking on whether any treatment is more effective than the others.
1488:
Ramachandran, V. S., Rogers-Ramachandran, D. C., Cobb, S. (1995). "Touching the phantom".
353:
285:
1406:"Phantom limb pain: a systematic neuroanatomical-based review of pharmacologic treatment"
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1569:
825:
752:
654:
Philosophical
Transactions of the Royal Society of London. Series B: Biological Sciences
572:
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17:
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Ahmed, A.; Bhatnagar, S.; Rana, S. P.; Ahmad, S. M.; Joshi, S.; Mishra, S. (2014).
1593:
1519:
1371:
1295:
1264:
1221:
849:
109:
1447:
Bosanquet, DC.; Glasbey, JC.; Stimpson, A.; Williams, IM.; Twine, CP. (Jun 2015).
2169:
1404:
McCormick, Z; Chang-Chien, G; Marshall, B; Huang, M; Harden, RN (February 2014).
148:
Despite the term "phantom limb" not being coined until 1871 by a physician named
2050:
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1622:
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381:
308:
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289:
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Barbin J., Seetha V., Casillas J.M., Paysant J., Pérennou D. (September 2016).
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2018:
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331:
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105:
96:
1978:
1303:
1248:
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Pare 500 years ago, there is still no detailed explanation of its mechanisms.
673:
833:
385:
318:
A mirror box used for treating phantom limbs, developed by V.S. Ramachandran
83:
2026:
1996:
1896:
1837:
1802:
1753:
1708:
1683:"Effectiveness of mirror therapy in phantom limb pain: A literature review"
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1321:
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1213:
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1107:
1047:
994:
733:
665:
1877:
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890:
841:
691:
588:
634:
327:
323:
304:
252:, where sensory information is represented somatotropically, forming the
2122:
1744:
1727:
1088:
629:
Nikolajsen, L., Jensen, T. S. (2006). McMahon S, Koltzenburg M (eds.).
157:
129:
1424:
1405:
228:
Pain, temperature, touch, and pressure information are carried to the
2134:
1503:
976:
366:
1355:
1278:
Alviar, Maria
Jenelyn M.; Hale, Tom; Dungca, Monalisa (2016-10-14).
961:"A review of current theories and treatments for phantom limb pain"
445:(9th ed.). K. Sembulingam and prema Sembulingam. p. 717.
369:, extraction of a tooth (phantom tooth pain) or removal of an eye (
1198:
10.1002/1531-8249(200012)48:6<842::AID-ANA4>3.0.CO;2-T
198:
Research continues into more precise mechanisms and explanations.
1941:
Volume 15, Number 1, 2008, pp. 5-16(12); retrieved July 30, 2016
31:"Phantom limb syndrome" redirects here. Not to be confused with
345:
One approach that has received public interest is the use of a
1072:"Postamputation pain: epidemiology, mechanisms, and treatment"
1280:"Pharmacologic interventions for treating phantom limb pain"
1681:
Campo-Prieto, P; Rodríguez-Fuentes, G (November 14, 2018).
751:
Nikolajsen, Lone; Christensen, Kristian
Friesgaard (2015),
2003:
Halligan, P.W. (2002), "Phantom limbs: The body in mind",
1337:"Phantom limb pain: a case of maladaptive CNS plasticity?"
1547:
Ramachandran, V. S., Rogers-Ramachandran, D. C. (1996).
413:, where sensations are felt in a limb that never existed
943:"Peripheral nervous system origin of phantom limb pain"
27:
Sensation that an amputated or missing limb is attached
706:
2112:
1910:
Ramachandran, V. S.; McGeoch, P. D. (January 2008).
1549:"Synaesthesia in phantom limbs induced with mirrors"
2116:
1237:
704:Woodhouse, Annie (2005). "Phantom limb sensation".
77:
51:
1861:"Phantom eye syndrome: A review of the literature"
1777:"Phantom tooth pain: a new look at an old dilemma"
1335:Flor, H; Nikolajsen, L; Jensn, T (November 2006).
2043:Amputation, Prosthesis Use, and Phantom Limb Pain
959:Collins, Kassondra L; Russell, Hannah G. (2018).
1959:Halligan, P.W.; Zeman, A.; Berger, A. (1999),
1628:Annals of Physical and Rehabilitation Medicine
104:Approximately 80–100% of individuals with an
8:
1666:: CS1 maint: multiple names: authors list (
1606:: CS1 maint: multiple names: authors list (
1557:Proceedings of the Royal Society of London B
1532:: CS1 maint: multiple names: authors list (
1070:Hsu, Eugene; Cohen, Steven P. (2013-02-13).
1284:The Cochrane Database of Systematic Reviews
863:Ramchandran, VS; Hirstein, William (1998).
791:
789:
2113:
1121:Kaur, Amreet; Guan, Yuxi (December 2018).
624:
622:
352:Although mirror therapy was introduced by
57:
48:
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1986:
1886:
1876:
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1640:
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1399:
1397:
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1311:
1156:
1138:
1097:
1087:
1037:
984:
917:
880:
681:
1123:"Phantom limb pain: A literature review"
1014:"Phantom limb pain: A literature review"
322:Most treatments are not very effective.
313:
1775:Marbach, J. J.; Raphael, K. G. (2000).
508:Chahine, Lama; Kanazi, Ghassan (2007).
433:
1659:
1599:
1525:
1065:
1063:
1061:
949:, Vol. 155, Issue 7, pages 1384-1391.
631:Wall & Melzack's Textbook of Pain
557:Melzack, R. (1992). "Phantom limbs".
468:"chapter 28 - Phantom Pain Syndromes"
7:
746:
744:
742:
474:, W.B. Saunders, pp. 304–315,
1830:10.1212/01.wnl.0000059547.68899.f5
919:10.1016/B978-0-12-812492-5.00020-6
765:10.1016/b978-0-12-802653-3.00051-8
648:Ramachandran, V. S. (1998-11-29).
581:10.1038/scientificamerican0492-120
480:10.1016/b978-0-7216-0334-6.50032-7
202:Differentiation of limb sensations
168:Pons and colleagues (1991) at the
25:
1912:"Phantom Penises in Transsexuals"
1012:Kaur, Amreet; Guan, Yuxi (2018).
865:"The perception of phantom limbs"
603:"Pain Perception in Phantom Limb"
510:"Phantom limb syndrome: A review"
1938:Journal of Consciousness Studies
1916:Journal of Consciousness Studies
1794:10.1046/j.1526-4637.2000.00012.x
718:10.1111/j.1440-1681.2005.04142.x
443:Essentials of medical physiology
441:Sembulingam, K. (11 July 2023).
2195:Phantom limb syndrome: A review
1933:Phantom Penises In Transsexuals
1127:Chinese Journal of Traumatology
1296:10.1002/14651858.CD006380.pub3
232:via the anterolateral system (
1:
422:Visual release hallucinations
175:Hearing about these results,
170:National Institutes of Health
40:Phantom limb (disambiguation)
759:, Elsevier, pp. 23–34,
2051:10.1007/978-0-387-87462-3_1
1935:, by V.S. Ramachandran; in
1642:10.1016/j.rehab.2016.04.001
1344:Nature Reviews Neuroscience
1140:10.1016/j.cjtee.2018.04.006
1030:10.1016/j.cjtee.2018.04.006
211:Types of phantom sensations
2242:
2197:M.E.J. ANESTH 19 (2), 2007
2045:, Springer, pp. 1–5,
1466:10.1016/j.ejvs.2015.04.030
411:Supernumerary phantom limb
29:
2099:10.4249/scholarpedia.8244
2068:Vilayanur S. Ramachandran
2019:10.1080/13546800244000111
2006:Cognitive Neuropsychiatry
1700:10.1016/j.nrl.2018.08.003
757:Nerves and Nerve Injuries
177:Vilayanur S. Ramachandran
95:is the sensation that an
72:
56:
1979:10.1136/bmj.319.7210.587
1453:Eur J Vasc Endovasc Surg
1249:10.1177/1534734611428730
1076:Journal of Pain Research
904:Ramchandran, VS (2020).
882:10.1093/brain/121.9.1603
361:Other phantom sensations
1966:British Medical Journal
1961:"Phantoms in the Brain"
910:Multisensory Perception
834:10.1126/science.1843843
2211:Neurological disorders
2070:, Brang David (2009).
1865:ScientificWorldJournal
1578:10.1098/rspb.1996.0058
666:10.1098/rstb.1998.0337
319:
242:primary sensory cortex
230:central nervous system
160:). By the late 1980s,
317:
144:Phantom limb syndrome
18:Phantom limb syndrome
371:phantom eye syndrome
336:Perineural catheters
262:somatosensory cortex
238:spinoreticular tract
234:spinothalamic tracts
38:For other uses, see
2090:2009SchpJ...4.8244R
1878:10.1155/2014/686493
1570:1996RSPSB.263..377R
1186:Annals of Neurology
826:1991Sci...252.1857P
820:(5014): 1857–1860.
797:Canadian Psychology
753:"Phantom Limb Pain"
660:(1377): 1851–1859.
637:. pp. 961–971.
573:1992SciAm.266d.120M
560:Scientific American
384:, but did occur in
150:Silas Weir Mitchell
33:Alien limb syndrome
1745:10.1111/papr.12089
1089:10.2147/JPR.S32299
320:
254:sensory homunculus
116:Signs and symptoms
2190:
2189:
2060:978-0-387-87461-6
1973:(7210): 587–588,
1564:(1369): 377–386.
1498:(6549): 489–490.
1425:10.1111/pme.12283
929:978-0-12-812492-5
489:978-0-7216-0334-6
452:978-93-5696-326-9
396:transgender men.
382:transgender women
246:postcentral gyrus
244:, located in the
224:Neural mechanisms
89:
88:
66:
46:Medical condition
16:(Redirected from
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1990:
1942:
1930:
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1907:
1901:
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1824:(9): 1542–1543.
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1504:10.1038/377489a0
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1468:
1444:
1438:
1437:
1427:
1401:
1390:
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1374:. Archived from
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1018:Chin J Traumatol
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1002:
988:
977:10.1172/JCI94003
971:(6): 2168–2176.
956:
950:
940:
934:
933:
921:
906:"Mirror therapy"
901:
895:
894:
884:
875:(9): 1603–1630.
860:
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853:
807:
801:
793:
784:
783:
782:
781:
748:
737:
712:(1–2): 132–134.
702:
696:
695:
685:
645:
639:
638:
633:(5th ed.).
626:
617:
616:
614:
613:
607:flipper.diff.org
599:
593:
592:
554:
548:
547:
545:
543:
537:
531:. Archived from
514:
505:
499:
498:
497:
496:
463:
457:
456:
438:
406:Neuropathic pain
340:local anesthetic
68:
67:
49:
43:
36:
21:
2241:
2240:
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2072:"Phantom touch"
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472:Pain Management
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386:transgender men
363:
354:VS Ramachandran
286:antidepressants
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134:weather changes
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417:Synesthesia
309:biofeedback
301:acupuncture
290:spinal cord
189:Tamar Makin
99:or missing
2221:Amputation
2205:Categories
2176:DiseasesDB
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1871:: 686493.
1732:Pain Pract
1687:Neurologia
1385:2012-04-16
780:2023-11-05
612:2022-12-15
517:MEJ Anesth
495:2019-12-09
428:References
390:mastectomy
347:mirror box
334:is mixed.
332:gabapentin
282:medication
106:amputation
2216:Syndromes
1818:Neurology
1304:1469-493X
1206:0364-5134
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726:0305-1870
674:0962-8436
394:operative
379:operative
294:vibration
276:Treatment
97:amputated
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79:Specialty
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1997:10473458
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635:Elsevier
542:July 20,
529:16240786
400:See also
328:morphine
324:Ketamine
305:hypnosis
284:such as
2170:D010591
2086:Bibcode
1988:1116476
1888:4273592
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297:therapy
248:in the
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377:post-
2165:MeSH
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1993:PMID
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