Final Project for Neurobiology course.

1. Understanding
the Brain:
Phantom Limb
Syndrome
By: Hannah Berman

2. What is Phantom Limb Syndrome?
Phantom Limb Syndrome is a condition where individuals who have
undergone an amputation experience sensations in a limb that no longer
exists. These sensations may occur after a medical amputation as well as
after accidental limb loss. The feeling may or may not be painful, it can
range in severity, and it can last anywhere from a few seconds to days or
even longer. Phantom pain typically occurs shortly after limb loss and
rarely presents months or years later.
Oftentimes, a person experiencing phantom sensations may forget that
their extremity is missing, and they may attempt to use it (try to walk on
both legs, reach for something with their hand, etc.) which may become
dangerous.

3. Categories
 Phantom pain: painful
sensations referred to the
missing limb
 Phantom sensation: any
sensation in the missing
limb, other than pain
 Stump pain: pain referred
to the amputation stump
 Telescoping: a progressive
sensation resulting in the
distal limb being perceived
more proximally

4. Phantom Pain
 Term coined by Silas Weir Michael in 1892
 50-80% of amputees feel phantom pain in the missing limb
 Factors that may trigger phantom limb pain:
 Angina, temperature changes, barometric pressure, sex, physical
touch, smoking, stress, and more.
 In upper limb amputees, pain is normally felt in the fingers and
palm of the hand.
 In lower limb amputees, pain is normally felt in the toes and
foot.

5. Symptoms
 Burning
 Aching
 Pinching
 Itching
 Tingling
 Shooting
 Stabbing
 Throbbing

6. Phantom Sensations
 Phantom sensation types (different
from pain):
 Kinetic (movement)
 Kinesthetic (size, shape, position)
 Exteroceptive (touch, pressure,
temperature, itch, vibration)

7. Stump Pain
 All patients experience some stump pain in the first week after
amputation.
 Stump pain and phantom limb pain are strongly correlated, and
phantom pain is often triggered by stump pain.
 Prolonged stump pain is usually attributed to local pathology –
delayed wound healing, infection, surgical complications, poor
prosthetic fit, neuromas, and adherent scars.
 Late onset stump pain are likely related to neuromas, prothetic
fit, claudication, bony overgrowth, osteosrthritis, and tumor
recurrence.

8. Telescoping
 Occurs in about
one third of
phantom limb
syndrome patients.
 The sensations
gradually approach
the stump and, in
time, becomes
attached to it.

9. Theories
 Peripheral Theories – Remaining nerves in the stump grow to form
neuromas, which generate impulses, and these impulses may be
perceived as pain in the location where the limb once was.
 Central Theories – Sensory experiences create a unique
neuromatrix, which is imprinted in the brain. When a limb is removed,
the neurons in the brain try to reorganize but the neurosignature
remains due to previously experienced pain prior to the amputation.
 Spinal Theories - When peripheral nerves are cut during
amputation, there is a loss of sensory input from the area below the
level of amputation. This results in a decrease of neurochemicals
which alters pain pathways.

10. Nervous System Roles
 When a limb is lost, damaged neurons often attempt to repair
themselves by growing new extensions. Without a limb to grow into,
the new extensions have nowhere to go, and they form a mass of
neural tissue called a neuroma. The neuroma can generate erratic
signals, which may underlie the sensations and pain associated with
phantom limb.
 Mirror Therapy, one of the most common treatment modalities for
Phantom Limb Pain, provides the brain with missing visual stimulation.
The reflection of the intact limb is optically superimposed on the
location of the amputated limb, tricking the brain into thinking that
the Phantom Limb is real.

11. Cortical Reorganization
 When a limb is lost, the
neurons in the somatosensory
cortex that used to respond to
signals from that limb begin to
respond to signals from other
nearby neurons. This can cause
sensations felt in other parts of
the body to lead to the
stimulation of neurons in the
somatosensory cortex devoted
to the now missing limb, which
causes the brain to perceive
sensations in the missing limb.

14. Treatments
 Ultrasounds and blood tests can help health care providers rule out
other causes of residual limb pain, like infections, and management
and treatment options for phantom limb pain can be explored.
Commonly recommended modalities to treat phantom pain include:
Acupuncture, Physical Therapy, Biofeedback, Transcutaneous
Electrical Nerve Stimulation (TENS), Sensory Discrimination Training,
Massage, Mindfulness, Meditation, and Mirror Therapy.
 Natural phantom limb pain tends to diminish in frequency and severity
over time, often with resolution over many weeks to a few years.
 Combining physical and occupational therapy with a cognitive
understanding of the condition will amplify the effects of treatment.

15. Mirror Therapy
 Mirror Therapy, one of the
most common treatment
modalities for Phantom
Limb Pain, provides the
brain with missing visual
stimulation. The reflection
of the intact limb is
optically superimposed on
the location of the
amputated limb, tricking
the brain into thinking that
the Phantom Limb is real.

16. My Takeaways from the Course
This course has taught me to be curious, ask questions, and do further
research into medical disorders and conditions that I come across daily.
Working at an inpatient drug and alcohol rehabilitation facility, we come
across an array of medical conditions. I used to read the patients’
conditions, do a super quick Google search on it, and move on. Since
enrolling in this course, I am more intentional with the treatment I
provide, as I spend time researching and understanding the condition and
how different parts of the body are impacted. I conduct EEGs, so
learning about how important the brain is in every single patient’s
medical diagnosis has been fascinating to me. I find myself questioning
things that I have never had a second thought about, and I am now able
to better understand how the patients’ lives are impacted from medical
conditions, by understanding what is happening in their brain and
nervous system.

17. “…today phantoms are the Holy Grail of neurobiology,
sacred objects with wondrous and enigmatic qualities that
assertedly deserve our collective curiosity and concern.”
(Cassandra S. Crawford, 2012)

18. Resources
Bailey, A. A., & Moersch, F. P. (1941). Phantom Limb. Canadian Medical Association journal, 45(1), 37–42.
Chahine, L., & Kanazi, G. (2007). Phantom Limb Syndrome-A Review. Middle East Journal of
Anesthesiology, 19(2), 345.
Crawford, C. S. (2013). ‘You don’t need a body to feel a body’: phantom limb syndrome and corporeal
transgression. Sociology of Health & Illness, 35(3), 434-448.
Makin, T. R., Scholz, J., Henderson Slater, D., Johansen-Berg, H., & Tracey, I. (2015). Reassessing cortical
reorganization in the primary sensorimotor cortex following arm amputation. Brain, 138(8), 2140-2146.
Pate, J. W. Can you still feel a limb that's gone? TED. Retrieved February 2, 2023, from
https://ed.ted.com/lessons/the-fascinating-science-of-phantom-limbs-joshua-w-pate
Phantom limb pain. Physiopedia. Retrieved February 2, 2023, from https://www.physio-
pedia.com/Phantom_Limb_Pain
Phantom limb pain: What is it, causes, treatment & outcome. Cleveland Clinic. (2021, May 12). Retrieved
February 2, 2023, from https://my.clevelandclinic.org/health/diseases/12092-phantom-limb-pain
Sherman, R. A. (1997). Phantom Limb Pain. Retrieved February 2, 2023, from
https://www.bfe.org/protocol/pro05eng.htm
U.S. Department of Health and Human Services. (2020, November 10). Next-Gen Device Could Relieve Phantom
Limb Pain. National Institutes of Health. Retrieved February 2, 2023, from
https://heal.nih.gov/news/stories/phantom-limb-pain