Review Article| Volume 15, ISSUE 1, P349-364, March 2014

Phantom Limb Pain and Its Psychologic Management: A Critical Review


      Phantom limb pain is a puzzling phenomenon, from the viewpoints of both the patient experiencing it and the clinician trying to treat it. This review focuses on psychologic aspects in the origin of the PLP and critically evaluates the various psychologic interventions in the management of PLP. Whereas pharmacologic and surgical treatments often fail, psychologic interventions may hold promise in managing PLP. Studies using cognitive-behavioral therapies and hypnotherapy are reviewed. The outcome reports for psychologic therapies have been mainly positive. The results of the majority of these studies show a reduction in PLP. However, the lack of well controlled and randomized trials makes it difficult to draw firm conclusions regarding the effectiveness of these psychologic therapies in the treatment of PLP.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Pain Management Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Arena J.G.
        • Sherman R.A.
        • Bruno G.M.
        • Smith J.D.
        The relationship between situational stress and phantom limb pain: Cross-lagged correlational data from six-month pain logs.
        Journal of Psychosomatic Medicine. 1990; 34: 71-77
        • Bamford C.
        A multifaceted approach to the treatment of phantom limb pain using hypnosis.
        Contemporary Hypnosis. 2006; 23: 115-126
        • Baron R.
        • Binder A.
        • Wasner G.
        Neuropathic pain: Diagnosis, pathophysiological mechanisms, and treatment.
        The Lancet Neurology. 2010; 9: 807-819
        • Belleggia G.
        • Birbaumer N.
        Treatment of phantom limb pain with combined EMG and thermal biofeedback: A case report.
        Applied Psychophysiology and Biofeedback. 2001; 26: 141-146
        • Borghi B.
        • d’Addabbo M.
        • White P.F.
        • Gallerani P.
        • Toccaceli L.
        • Raffaeli W.
        • Tognù A.
        • Fabbri N.
        • Mercuri M.
        The use of prolonged peripheral neural blockade after lower extremity amputation: The effect on symptoms associated with phantom limb syndrome.
        Anesthesia and Analgesia. 2010; 111: 1308-1315
        • Brodie E.E.
        • Whyte A.
        • Niven C.A.
        Analgesia through the looking-glass? A randomized controlled trial investigating the effect of viewing a "virtual" limb upon phantom limb pain, sensation and movement.
        European Journal of Pain. 2007; 11: 428-436
        • Brown G.W.
        • Summers D.
        • Coffman B.
        • Riddel R.
        • Poulsen B.
        The use of hypnotherapy in school-age children: Five case studies.
        Psychotherapy in Private Practice. 1996; 15: 53-65
        • Chan R.
        Hypnosis and phantom limb pain.
        Australian Journal of Clinical and Experimental Hypnosis. 2006; 34: 55-64
        • Chan B.L.
        • Witt R.
        • Charrow A.P.
        • Magee A.
        • Howard R.
        • Pasquina P.F.
        • Heilman K.M.
        • Tsao J.W.
        Mirror therapy for phantom limb pain.
        New England Journal of Medicine. 2007; 357: 2206-2207
        • Chaves J.F.
        Hypnosis in the management of phantom limb pain.
        in: Dowd T. Healy J. Case studies in hypnotherapy. Guildford Press, New York1986: 198-209
        • Chaves J.F.
        Hypnosis in pain management.
        in: Rhue R.H. Lyn S.J. Kirsch I. Handbook of clinical hypnosis. American Psychological Association, Washington, DC1993: 511-532
        • Costigan M.
        • Scholz J.
        • Woolf C.J.
        Neuropathic pain: A maladaptive response of the nervous system to damage.
        Annual Review of Neuroscience. 2009; 32: 1-32
        • Dawson L.
        • Arnold P.
        Persistent phantom limb pain.
        Perception and Motor Skills. 1981; 53: 135-138
        • de Roos C.
        • Veenstra A.C.
        • de Jongh A.
        • den Hollander–Gijsman M.
        • van der Wee N.J.
        • Zitman F.G.
        • van Rood Y.R.
        Treatment of chronic phantom limb pain using a trauma-focused psychological approach.
        Pain Research and Management. 2010; 15: 65-71
        • Dernham P.
        Phantom limb pain.
        Geriatric Nursing. 1986; 7: 34-37
        • Dougherty J.
        Relief of phantom limb pain after EMG biofeedback-assisted relaxation: A case report.
        Behaviour Research and Therapy. 1980; 18: 355-357
        • Ephraim P.L.
        • Wegener S.T.
        • MacKenzie E.J.
        • Dillingham T.R.
        • Pezzin L.E.
        Phantom pain, residual limb pain, and back pain in amputees: Results of a national survey.
        Archives of Physical Medicine and Rehabilitation. 2005; 86: 1910-1919
        • Ersland L.
        • Rosen G.
        • Lundervold A.
        • Smievoll A.I.
        • Tillung T.
        • Sunderberg H.
        • Hugdahl K.
        Phantom limb imaginary finger tapping causes primary motor cortex activation: An fMRI study.
        NeuroReport. 1996; 8: 207-210
        • Flor H.
        • Denke C.
        • Schaefer M.
        • Grusser M.
        Sensory discrimination training alters both cortical reorganization and phantom limb pain.
        Lancet. 2001; 357: 1763-1764
        • Flor H.
        Phantom limb pain: Characteristics, causes, and treatment.
        The Lancet Neurology. 2002; 1: 182-189
        • Flor H.
        • Nikolajsen L.
        • Jensen T.S.
        Phantom limb pain: A case of maladaptive CNS plasticity.
        Nature Reviews Neuroscience. 2006; 7: 873-881
        • Freedman R.R.
        Physiological mechanisms of temperature feedback.
        Biofeedback and Self Regulation. 1991; 16: 95-115
        • Gallagher P.
        • Allen D.
        • MacLaclan M.
        Phantom limb pain and residual pain following lower limb amputation: A descriptive analysis.
        Disability and Rehabilitation. 2001; 23: 522-530
        • Giummarra M.J.
        • Moseley G.L.
        Phantom limb pain and bodily awareness: Current concepts and future directions.
        Current Opinions in Anaesthesiology. 2011; 24: 524-531
        • Harden N.R.
        • Houle T.T.
        • Green S.
        • Remble T.A.
        • Weinland S.R.
        • Colio S.
        • Lauzon J.
        • Kuiken T.
        Biofeedback in the treatment of phantom limb pain: A time-series analysis.
        Applied Psychophysiology and Biofeedback. 2005; 30: 83-93
        • Hawkins R.M.F.
        A systematic meta-review of hypnosis as an empirically supported treatment for pain.
        Pain Review. 2001; 8: 47-73
        • Hilgard E.R.
        • Hilgard J.R.
        Hypnosis in the relief of pain.
        William Kaufman Inc, LA1975
        • Hill A.
        • Niven C.A.
        • Knussen C.
        The role of coping in adjustment to phantom limb pain.
        Pain. 1995; 62: 79-86
        • Iannetti G.D.
        • Mouraux A.
        From the neuromatrix to the pain matrix (and back).
        Experimental Brain Research. 2010; 205: 1-12
        • Katz J.
        The reality of phantom limbs.
        Motivation and Emotion. 1993; 17: 147-179
        • Karanikolas M.
        • Aretha D.
        • Tsolakis I.
        • Monantera G.
        • Kiekkas P.
        • Papadoulas S.
        • Swarm R.A.
        • Filos K.S.
        Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency: A prospective, randomized clinical trial.
        Anesthesiology. 2011; 114: 1144-1154
        • LeBaron S.
        • Zeltaer L.K.
        Children in pain.
        in: Barber J. Hypnosis and suggestion in the treatment of pain: A clinical guide. Norton, New York1996: 305-340
        • Linton S.J.
        A critical review of behavioural treatments for chronic benign pain other than headache.
        British Journal of Clinical Psychology. 1982; 21: 321-337
        • Louis E.D.
        • York G.K.
        Weir Mitchell’s observations on sensory localization and their influence on Jacksonian neurology.
        Neurology. 2006; 66: 1241-1244
        • McCabe C.S.
        • Haigh R.C.
        • Ring E.F.J.
        • Halligan P.W.
        • Wall P.D.
        • Blake D.R.
        A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1).
        Rheumatology. 2003; 42: 97-101
        • McLachlan M.
        • McDonald D.
        • Waloch J.
        Mirror treatment of lower limb phantom pain: A case study.
        Disability and Rehabilitation. 2004; 26: 901-904
        • Melzack R.
        Evolution of the neuromatrix theory of pain. The Prithvi Raj Lecture. Presented at the Third World Congress of World Institute of Pain, Barcelona 2004.
        Pain Practice. 2005; 5: 85-94
        • Montgomery G.H.
        • DuHamel K.N.
        • Redd K.N.
        A meta-analysis of hypnotically induced analgesia: How effective is hypnosis?.
        International Journal of Clinical and Experimental Hypnosis. 2000; 48: 138-153
        • Morgenstern F.S.
        The effects of sensory input and concentration on post-amputation phantom limb pain.
        Journal of Neurology, Neurosurgery and Psychiatry. 1964; 27: 58-65
        • Morley S.
        • Eccleston C.
        • Williams A.
        Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache.
        Pain. 1999; 80: 1-13
        • Moseley L.G.
        Graded motor imagery for pathologic pain: A randomized controlled trial.
        Neurology. 2006; 67: 2129-2134
        • Muraoka M.
        • Komiyama H.
        • Hosoi M.
        • Mine K.
        • Kubo C.
        Psychosomatic treatment of phantom limb pain with post-traumatic stress disorder: A case report.
        Pain. 1996; 66: 385-388
        • Oakley D.A.
        • Gracey-Whitman L.
        • Halligan P.W.
        Hypnotic imagery as a treatment for phantom limb pain: Two case reports and a review.
        Clinical Rehabilitation. 2002; 16: 368-377
        • Parkes C.M.
        Factors determining the persistence of phantom pain in the amputee.
        Journal of Psychosomatic Research. 1973; 17: 97-108
        • Patterson D.R.
        • Jensen M.P.
        Hypnosis and clinical pain.
        Psychological Bulletin. 2003; 129: 495-521
        • Ramachandran V.S.
        • Brang D.
        • McGeogh P.D.
        Size reduction using mirror visual feedback (MVF) reduces phantom pain.
        Neurocase. 2009; 15: 357-360
      1. Rickard, J. A. (2005). Effects of hypnosis in the treatment of residual stump pain and phantom limb pain. Retrieved July 10, 2007, from

        • Rosen G.
        • Willoch F.
        • Bartenstein P.
        • Berner N.
        • Rosjo S.
        Neurophysiological processes underlying the phantom limb experience and the use of hypnosis in its management: An intensive examination of two patients.
        International Journal of Experimental Hypnosis. 2000; 49: 38-55
      2. Roux, F.E., Ibarrola, D., Lazorthes, Y., & Berry, I. (2008). Chronic motor cortex stimulation for phantom limb pain: A functional magnetic resonance imaging study: Technical case report. Neurosurgery, 62(6), SHC978–SHC984.

        • Russell M.C.
        Treating traumatic amputation-related phantom limb pain: A case study utilizing eye movement desensitization and reprocessing within the armed services.
        Clinical Case Studies. 2008; 7: 136-153
        • Schneider J.
        • Hofmann A.
        • Rost C.
        • Shapiro F.
        EMDR and phantom limb pain, theoretical implications, case study, and treatment guidelines.
        Journal of EMDR Practice and Research. 2007; 1: 45
        • Schneider J.
        • Hofmann A.
        • Rost C.
        • Shapiro F.
        EMDR in the treatment of chronic phantom limb pain.
        Pain Medicine. 2008; 9: 76-82
        • Seidel S.
        • Kasprian G.
        • Sycha T.
        • Auff E.
        Mirror therapy for phantom limb pain—A systematic review.
        Wien Klin Wochenschr. 2009; 121: 440-444
        • Siegel E.F.
        Control of phantom limb pain by hypnosis.
        American Journal of Clinical Hypnosis. 1979; 21: 285-286
        • Shapiro F.
        Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures.
        2nd ed. Guilford Press, New York2001
        • Sherman R.A.
        • Sherman C.J.
        • Gormly J.
        Treatment of phantom limb pain with muscular relaxation training to disrupt the pain-anxiety-tension cycle.
        Pain. 1979; 6: 47-55
        • Sherman R.A.
        • Sherman C.J.
        • Gall N.G.
        A survey of current phantom limb treatment in the United States.
        Pain. 1980; 8: 85-99
        • Sherman R.A.
        • Sherman C.J.
        • Bruno G.M.
        Psychological factors influencing phantom limb pain.
        Pain. 1987; 28: 285-295
        • Shukla G.D.
        • Sahu C.
        • Tripathi R.P.
        • Gupta D.
        Phantom limbs: A phenomenological study.
        British Journal of Psychiatry. 1982; 141: 54-58
        • Spring J.
        Neural plasticity and the progress of phantom pain research mind matters.
        The Wesleyan Journal of Psychology. 2010; 5: 13-26
        • Sumitani M.
        • Miyauchi S.
        • McCabe C.S.
        • Shibata M.
        • Maeda L.
        • Saitoh Y.
        • Tashiro T.
        • Mashimo T.
        Mirror visual feedback alleviates deafferentation pain, depending on qualitative aspects of the pain: a preliminary report.
        Rheumatology. 2008; 47: 1038-1043
        • Turk D.C.
        A cognitive-behavioural perspective on treatment of chronic pain patients.
        in: Turk D.C. Gatchel R.J. Psychological approaches to pain management. Guildford Press, New York2002: 138-158
        • Weeks S.R.
        • Anderson-Barnes V.C.
        • Tsao J.W.
        Phantom limb pain: Theories and therapies.
        Neurologist. 2010; 16: 277-286
        • Wetering E.J.V.D.
        • Lemmens K.M.M.
        • Nieboer A.P.
        • Huijsman R.
        Cognitive and behavioral interventions for the management of chronic neuropathic pain in adults—A systematic review.
        European Journal of Pain. 2010; 14: 670-681
        • Whyte A.N.
        • Niven C.A.
        Psychological distress in amputees with phantom limb pain.
        Journal of Pain and Symptom Management. 2001; 22: 938-946
        • Wilensky M.
        Eye movement desensitization and reprocessing (EMDR) as a treatment for phantom limb pain.
        Journal of Brief Therapy. 2006; 5: 31-44