Nerve damage and phantom limb pain due to amputation

Sometimes – for example due to a serious accident – an amputation is unavoidable. The surgical severing of a body part inevitably results in the severing of nerves, which in the further course can lead to complaints. But how exactly does nerve damage due to amputation manifest itself?? What is phantom limb pain?? And in what way can they be treated? We will answer these and other questions.

  • Amputation
  • Amputation reasons
  • Phantom limb pain
  • Phantom limb pain treatment

Man wearing a prosthetic leg due to an amputation

What is an amputation?

An amputation is the Separation of a body part in the course of an operation or an accident (for example, the loss of a finger during a mowing operation). In the context of medical interventions – for example, due to a circulatory disorder – the legs are among the limbs that are most frequently amputated. 1

A doctor does not consider amputation lightly. Only when there is really no other therapeutic option, to preserve the body part, or when a person’s life is threatened (for example, in the case of blood poisoning) the operation is performed. In addition, surgeons only ever separate as much of the body as is really necessary. This means that a person’s leg is only removed when it is severely damaged (cells have died) and/or would cause permanent excruciating pain. Among other things, serious traffic accidents can lead to this.

Good to know

Whenever possible, experts try to operate in such a way as to create a residual limb that makes it possible to wear a Prosthesis (artificial body part replacement) possible. Because this preserves the quality of life of their patients better.

For stump formation, after a body part is separated, special instruments are used to round off the remaining bone so that it is not sharp and injures tissue. The doctors then place a soft tissue flap over the bone and the open surgical site and sew it up.

Possible causes of amputation

There are many reasons why a person may need an amputation. They include, for example:

  • Tumors and infections
  • Accidents
  • Arterial occlusive disease

Eighty percent of all amputations are due to peripheral arterial occlusive disease (pAVK) due to. 1

In this disease, harmful narrowing of arteries occurs mostly in the legs. The result is circulatory disorders, which can lead to nerve damage and cell death. This is dangerous because dead tissue not only causes pain, but also poses a high risk of life-threatening infections. The main Cause of peripheral arterial occlusive disease – also called shop window disease – is, by the way, a Arteriosclerosis (hardening of the arteries).

Risk factors for pAVK include:

  • smoking
  • older age
  • diabetes mellitus (diabetes)
  • High blood pressure
  • elevated blood lipid levels

As a rule, patients of advanced age have pAVK. For this reason most amputees are over 60 years old. 1

Body Integrity Identity Disorder (BIID): Voluntary Amputation?

In BIID (also known as Body Integrity Identity Disorder), those affected suffer from a deep sense that one of their body parts is completely alien – does not belong to their body. They would like to have this part (usually a leg) amputated voluntarily.

In Germany, such operations, that is, amputations without medical necessity, are not allowed. However, those affected in this country receive support, for example, from psychotherapists or BIID self-help groups. The problem is that for most people, the desire to amputate is very alienating. And so many sufferers often do not dare to speak openly with someone about it.

Phantom limb pain as a possible consequence of amputation

There is hardly an amputee who doesn’t feel his or her removed body part – at least now and then. 2 Sufferers report

  • phantom feelings (the removed part of the body is felt) and
  • Phantom moves (even if the person knows, for example, that his left arm is missing, it is as if he can still move it).

As soon as a patient perceives phantom sensations or phantom movements as painful, doctors speak of phantom pain. 2

Phantom pain is a normal reaction of the brain to a distant body part. In addition, this pain is a special kind of nerve pain, as they can appear for example with nerve injuries.

Possible complications directly after surgery

In addition to phantom limb pain, these phenomena, among others, are conceivable after medical removal of limbs:

  • the Wound bleeds after
  • a Infection Occurs at the surgical site
  • the Wound healing is disturbed
  • the stump hurts

Therefore, hospitalization is required after each amputation. The medical staff takes care of the wound in the best possible way. When the surgical site has healed sufficiently so that the patient can go home again, the attending physician decides.

How do phantom pains develop?

The brain receives continuous feedback from the rest of the body – i.e. from the skin, tendons, nerves, muscles and so on. This forms a "map" of the entire organism in order to coordinate, among other things, the control of movement sequences.

If the arm is amputated, for example, the brain can no longer update its "map" of the body correctly. Therefore it tries now to win the missing data over other ways. This information can be, for example, memories of sensations in the past. Sometimes the brain makes use of painful memories, such as an already past inflammation of the nerves in the arm. 2

How phantom limb pain manifests itself?

Phantom limb pain is sometimes constantly present or fluctuate during the day in their intensity. For example, a patient who has lost a leg may feel in the morning as if someone had stabbed him in the calf, while a few hours later he perceives the pain only as a burning sensation. 2

Worth knowing

Mostly it comes with concerning Days or weeks after the amputation for the first time to the appearance of phantom limb pain. It varies greatly from patient to patient how long the pain lasts. Now and then they disappear suddenly with or without therapy. As a rule, however, they remain or reappear at a later point in life. 2

Phantom limb pain versus stump pain

In addition to phantom limb pain, a person who has undergone surgery may also experience stump pain. Responsibilities include:

  • Circulatory disorders (for example due to a too tight bandage)
  • Pressure points (e.g. due to an ill-fitting prosthesis)
  • Wound pain
  • Nerve pain

The latter are often triggered by a proliferation (neuroma) of a nerve severed in the course of amputation. 2


By definition, stump pain always ends up on the stump of someone being treated. 2 However, they occasionally go into phantom pain. If this is the case, physicians speak of mixed stump and phantom pain.

Therapy: How to treat phantom pains?

Options for relieving phantom limb pain include:

As a rule, the attending physician discusses with his patient which of the above options is the most recommendable for treating the pain.

Treatment with medication

If there is corresponding pain, physicians have the option of Painkillers to prescribe. In terms of phantom limb pain treatment, a combination of

  • Anticonvulsants (remedy against seizures),
  • opioids (very strong painkillers) as well as
  • Antidepressants (drugs for depression) has proven effective.

Antidepressants are often used to treat depressive disorders, but they are also effective – even at low doses – against nerve pain, since they inhibit the transmission of pain. 2 The situation is similar with anticonvulsants. As soon as the patient no longer needs painkillers according to the doctor in charge, they are discontinued or slowly reduced again in consultation.

What does mirror therapy accomplish?

As a rule, a mirror therapy is carried out at the beginning in the clinic together with a Physiotherapists. Later – after about thirteen exercise units – it can be done independently at home. 3 But what happens?

Suppose a leg was amputated. Then the therapist places a mirror next to the intact leg. When the patient now looks in the mirror, it appears that both legs are still present. When moving the healthy leg it seems as if the phantom limb is active.

In many amputees, this illusion leads to a Deception of the brain. It now thinks that the removed leg is back and sends information. The result: the brain calms down and the pain subsides – sometimes for a long time.

Imagination exercises – another possibility of treatment

Another term for an imagination exercise is Imagination Exercise. Under the guidance of a physiotherapist, a patient should first recall in detail the foot that was removed, for example, as it was before the removal.

The patient is then asked to mentally move his foot. If this performance works well, a Similar effect as with mirror therapy occur, which leads to the relief of the phantom pain.

Treatment of phantom limb pain with relaxation techniques

Relaxation methods such as Progressive muscle relaxation sometimes reduces psychological stresses that can aggravate pain. In combination with other phantom pain therapy methods such as imagination exercises, relaxation techniques are therefore a proven therapy tool.

This becomes a little more understandable if one remembers that there are to maintain health for the organism is important that it is not constantly under tension. However, serious events such as an amputation make it difficult for a person to feel relaxed and calm. Or, to put it in other words, not having stress.

Physicians are also aware of this fact. Therefore, patients usually receive more detailed information about the various relaxation techniques and how they can be learned while still in the hospital. It varies greatly from individual to individual which of the possible methods will best help a person. One person tends to relax by meditating regularly and the other with the help of a good book.

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