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After an amputation, many individuals commonly feel as though their amputated limb is still there. In fact, research has shown that 60%-80% of amputees develop a condition known as phantom limb pain (PLP), or the perception of pain or discomfort in a missing limb. Pain, tingling, cramping, burning, pressure, or itching in the area where the limb once was are often a result of the nerve endings at the site of the amputation continuing to send pain signals to the brain.
Your pain is real – and our team at The Institute for Advanced Reconstruction is here to be your partner in your relief through targeted muscle reinnervation surgery (TMR).
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Understanding Neuroma & Phantom Limb Pain
What is Phantom Limb Pain?
Phantom limb pain is the sensation of pain in a limb that has been amputated. It is a type of chronic pain that can affect people who have undergone an amputation, and it can range in intensity from mild to severe. The pain is often described as a shooting, stabbing, or burning sensation, and it can be localized to the area where the limb was amputated or it can be felt throughout the body. Phantom limb pain can be difficult to treat and may require a combination of medications, physical therapy, and other therapies to manage the pain. It is important for people experiencing phantom limb pain to work with their healthcare team to find the most effective treatment plan. An estimated 85% of people who have lost a limb will experience phantom limb pain.
Symptoms
Phantom limb pain usually begins shortly after surgery. The amputee might feel pain where the missing limb should be. The pain can occur within the first week of the amputation or can be delayed for months after. Phantom limb pain is commonly described as:
- Shooting
- Stabbing
- Cramping
- Burning
- Pins and needles
- Throbbing
Causes
While the exact cause of phantom limb pain is unknown, many experts believe that the pain can be a response to mixed signals from the brain. When a body part is missing, this can cause the brain to signal that something is not right, which, in turn, can cause the brain to misinterpret the information it receives, processing signals as sensations of pain.
A neuroma can also contribute to phantom limb pain. During an amputation, the nerves that send information between that limb and the brain are severed. The end of those severed nerves can sometimes grow into a disorganized mass known as a neuroma. A neuroma can send confusing signals to the brain, leading to pain and discomfort and limited motion for the patient. Neuroma symptoms can include:
- Tingling sensations
- Tender to the touch
- Shooting sensation from a prosthetic
Risk Factors
The risk factors for developing phantom limb pain include the following:
- Age: Phantom limb pain is more common in older adults.
- Type of amputation: Phantom limb pain is more likely to occur after lower limb amputations, particularly those that involve the knee or ankle.
- Level of amputation: Phantom limb pain is more likely to occur after higher-level amputations, such as those that involve the thigh or hip.
- Previous pain: People who have experienced chronic pain in their limb prior to amputation may be at higher risk for developing phantom limb pain.
- Psychological factors: People who have high levels of anxiety or depression may be more likely to experience phantom limb pain.
- Quality of surgical technique: Poorly performed amputations or those that result in nerve damage may increase the risk of developing phantom limb pain.
- Duration of pre-amputation pain: The longer a person experiences pain before an amputation, the more likely they are to experience phantom limb pain.
Testing and Diagnosis
Phantom limb pain is diagnosed based on the patient's self-report of pain in a limb that has been amputated. It is important that providers listen carefully to the patient's description of the pain and how it feels. Your provider may also ask questions about your medical history, including the type and level of amputation, any previous pain in the limb, and overall health.
In some cases, additional tests may be conducted to rule out other potential causes of the pain, such as nerve damage or infection. These tests may include imaging studies, such as X-rays or MRI scans, or nerve conduction studies.
Phantom Pain Treatment using TMR
TMR is an advanced surgical procedure that involves transferring the sensory nerves that once provided sensation to an amputated limb to reinnervate other muscles to disrupt the painful sensory sensation. Following surgery, the nerves grow back into the new muscles thereby disrupting the sensory signal pathway and thus stopping the pain mechanism and phantom limb sensation. This procedure also prevents misdirected nerve growth, or neuroma formation, which can contribute to pain within the residual limb and/or cause PLP.
TMR surgery can occur at the same time as or after an amputation to prevent neuromas from forming and causing phantom limb pain. TMR can also help with prosthetics, making them more comfortable and improving your ability to use and control them.
TMR surgery takes about two to four hours and can require a hospital stay of up to five days. After the procedure, most individuals will experience surgery-related pain but no nerve pain. The nerves will regenerate or “wake up” soon after surgery, causing an increase in pain. Your doctor may prescribe pain management medication; however, the need for medicine should decrease as the nerves heal.
Our Doctors
The surgeons at The Institute for Advanced Reconstruction are renowned for their revolutionary nerve procedures and treatments for patients suffering from neuroma and phantom limb sensation after amputation. Using groundbreaking techniques, we help our patients find relief and return to their daily lives.
Patient Stories
Are you trying to imagine a future without phantom limb pain? Find out how our patients have found a new quality of life after TMR surgery.
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Insurance Information
The Institute for Advanced Reconstruction participates in a wide range of insurance plans, including those listed below. However, each physician has their own accepted insurance and hospital affiliations. Before scheduling an appointment, please contact your insurance carrier to confirm that your provider is in-network.
If we are not an in-network provider, our friendly insurance specialists will help you find the most coverage available for your treatment.
- Horizon Blue Cross Blue Shield of New Jersey
- Medicare
- Railroad Medicare
- Aetna
- Cigna
- United Healthcare
- Oxford (Freedom, Liberty)
- MagnaCare
Patient Resources
The Institute for Advanced Reconstruction has locations all over the nation with expert surgeons ready to help you.
Learn more about what to expect when it comes to surgical procedures and treatments at the Institute for Advanced Reconstruction by visiting our patient resource page.
Am I a candidate?
Schedule an appointment today and find out if TMR surgery is an option for treating your phantom limb pain.
What is Phantom Limb Pain?
Phantom limb pain is the sensation of pain in a limb that has been amputated. It is a type of chronic pain that can affect people who have undergone an amputation, and it can range in intensity from mild to severe. The pain is often described as a shooting, stabbing, or burning sensation, and it can be localized to the area where the limb was amputated or it can be felt throughout the body. Phantom limb pain can be difficult to treat and may require a combination of medications, physical therapy, and other therapies to manage the pain. It is important for people experiencing phantom limb pain to work with their healthcare team to find the most effective treatment plan. An estimated 85% of people who have lost a limb will experience phantom limb pain.