Phantom pain - when the pain remains even though the body is missing
How physiotherapy and occupational therapy can provide effective support for phantom limb pain after amputations
A foot that burns - even though it is no longer there. A pulling sensation in an arm that has been amputated. Phantom pain is one of the most impressive examples of how strongly our nervous system can continue to "feel" the body even after an amputation - and sometimes make it "suffer".
Many patients find this pain particularly agonizing and irritating: How can a part of the body that no longer exists hurt? And what can be done about it?
What is phantom limb pain?
Phantom pain is the sensation of pain in a part of the body that has been amputated - in other words, pain without a physical correlate. Up to 80% of all people who have had an amputation experience it in varying degrees of intensity and duration. It is not "imaginary" pain, but a real, neurophysiological reaction of the brain to the loss.
Frequent accompanying symptoms:
Phantom perception: the feeling that the body part is still there
Phantom movements: Twitching, cramps
Tingling, burning, stinging, electrifying pain sensations
Why does phantom pain occur?
Phantom limb pain is a prime example of the brain's plasticity - its ability to adapt to changing conditions. If a body part is amputated, the input from this area is missing. The brain reacts by reorganizing the sensory representations:
The neighboring areas in the somatosensory cortex take over the orphaned region → e.g. the representation of the lip takes over the region of the amputated arm
This "shift" can lead to misinformation and painful sensations
At the same time, the neuronal memory of the body part remains - including pain processing
The spinal cord, peripheral nerve stumps (neuromas) and psychological factors such as stress or emotional strain can also increase phantom pain.
What can therapy achieve?
Even though phantom pain is complex, there are promising therapeutic approaches - especially through a targeted combination of neurophysiological, sensory and body-oriented therapy.
Physiotherapeutic strategies
1. desensitization and sensory re-mapping
Aim: to calm the overstimulated nervous system and "reprogram" neuronal patterns
Methods:
Mirror therapy: visual feedback on the intact body part → Promote reorganization of the brain
Vibration stimuli on the residual limb or adjacent areas
Touch exercises with different textures
2. mobilization and stump care
Strengthening, stretching and mobilization of adjacent structures
Scar treatment, mobilization of skin and tissue
Relief of muscle tension that contributes secondarily to pain
3. medical yoga and breathing therapy
Calming of the autonomic nervous system
Tension regulation through conscious movement, breathing connection and body awareness
Experiencing the body "as a whole", despite amputation
🟡 Occupational therapy perspectives
1. body image work & neurocognitive integration
Work with body outline drawings, imagination exercises ("How does your leg feel today?")
Strengthening self-awareness and coherence between body awareness and reality
2. everyday training & pacing
Pain-reducing strategies in everyday life (e.g. positioning, change of position)
Energy management for chronic exhaustion caused by pain
3. resource work & dealing with triggers
Identification of amplifiers (stress, cold, emotions)
Develop positive, regulating activities: Music, art, gardening, breathing
The role of pain memory, amygdala & hippocampus
Phantom pain also has an emotional and cognitive component:
Amygdala (danger memory) is often overactivated - this increases sensitivity to pain
Hippocampus (experience link) can be strengthened through mindfulness, movement, meditation → better emotional integration of the new physical reality
Long-term therapy goals should therefore also promote self-efficacy, security and reorientation.
Conclusion: phantom pain is real - and treatable
Phantom pain shows how strongly the nervous system can generate pain even without a "real" stimulus - and how important it is to treat it holistically. Physiotherapy and occupational therapy can help to realign the brain, calm the nervous system and discover new ways of dealing with one's own body.
The focus is not on the "missing" body part - but on the still whole person who wants to be accompanied with all their senses, resources and abilities.
👉 Are you a therapist and want to learn more about complex pain phenomena, body image work and neurophysiological rehab?
Then discover our training courses for pain physiology, sensorimotor training and body-oriented therapy:
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