When Royal Navy officer and British national hero Lord Nelson lost his arm in battle in 1797, he considered his “phantom limb pain” to be “direct proof of the existence of the soul.” Regardless of your spiritual leanings, you have to admit that being able to “feel” an arm or leg that isn’t there is a pretty extraordinary thing. Phantom limb syndrome following the loss of a limb involves way more than just “sensing” phantom pain: there are plenty of fascinating accounts in the medical literature that reveal the phantom limb phenomenon as further evidence of the extraordinary power of the human mind (or soul, if you’re into that).
While you recover after losing a limb, you might experience a number of “phantom” sensations, depending on how the limb was lost. Your phantom limb may wave involuntarily, or even “retain” the “memory” of a wedding ring or wristwatch. There’s even a chance you could lose both arms and still experience arthritis in your “phantom hands” in the winter. You could even lose the phantom after decades, only to regain it by rubbing on your stump, “releasing” it like a genie from a bottle. Read on for a detailed look into what the phantom limb phenomenon is all about.
Phantom Limbs Are Extraordinarily Common
The chances of experiencing a so-called “phantom limb” after losing a real limb are extraordinarily high: Dr. V.S. Ramachandran—the man Richard Dawkins calls “The Marco Polo of Neuroscience”—writes in Brain: A Journal of Neurology that “between 90 and 98% of all patients experience a vivid phantom” almost immediately after losing a limb. In 75% of these cases, the phantom returns after the anesthetic wears off. In the remaining 25%, the phantom’s return is delayed for as long as a few weeks.
Ramachandran says patients with phantom limbs “experience an amputated extremity as still present, and in some cases also experience pain or cramping.” And that’s only the beginning. . .
Sometimes Just a “Phantom Hand” Will “Dangle from the Stump”
In a phenomenon known as “telescoping,” some patients experience a “fading” of the phantom limb until it is nothing but a hand, “dangling from the stump.” This occurs in roughly 50% of cases, according to Dr. Ramachandran. Why does the brain allow the rest of the phantom limb to fade?
One theory is that the hand is “over-represented” in the somatosensory cortex, the main sensory receptive area in the brain for the sense of touch, which is called “cortical magnification.” The lack of visual feedback from a phantom arm creates a “sensory conflict” that the brain deals with by “fading” it out, leaving the “over-represented” hands behind.
The Phantom Limb Could Hurt for Decades
Phantom limb sensations may only last “for a few day or weeks, then gradually fade from consciousness,” but they could also last for years. In about 30% of cases, the sensations last for decades. There are even fringe cases of phantoms lasting 44 and 57 years.
Kids Seem Weirdly “Immune” to Phantom Limbs
Kids don’t seem to experience phantom limbs nearly as frequently as adults. A 1962 study showed that only 61% of child amputees between 4 and 6 and 75% between 6 and 8 reported the phantoms (compare that to the 90-98% of adults). Once they’re more than 8 years old, kids seem to report them just as frequently as adults.
Why? Experts think it may be because there has not been enough time “for the body image to consolidate” in younger kids.
Rubbing the Stump Can Bring Back a Lost Phantom Limb
Once lost, the sensation of a phantom limb can be “recalled” through “intense concentration or sometimes merely by rubbing the stump.” Weir Mitchell in 1872 was also able to “revive” a phantom limb by applying “faradic stimulation” (a form of low-frequency electrical stimulation) to the stump of an above-knee amputee.
These findings could help explain why the “widespread clinical opinion,” according to Dr. Ramachandran, is that neuromas (aka “pinched nerves”) are the “primary cause of phantom limbs.” Ramachandran argues that it’s more complicated than that, especially considering that people born without limbs also experience phantoms.
Phantom Limbs Can Get Stuck in Painful Poses
Phantom limbs can sometimes assume awkward or even painful poses against the will of the amputee. These may range from the relatively benign, such as your phantom arm twisted behind your head after you wake up in the morning, to the god-awful, such as the report of a soldier that lost his arm to a grenade. The grenade went off in his hand, rendering his phantom hand in a “permanently clenched and painful posture.”
Inanimate Objects Can “Merge” with the Phantom Limb
Phantom limbs aren’t just an “illusion” of a missing arm or limb: they can also merge with objects such as splints. One patient that had his arm amputated while gripping a vertical wooden splint tightly reported that the splint was evident in his phantom. His phantom fingers, in other words, felt like they were “hooked over the end” of a phantom splint. There are also cases of the “memories” of wedding rings or watch bands continuing to exist with the phantoms.
Traumatic Limb Loss Creates More “Vivid” Phantoms
There’s a connection between how traumatic the limb loss was and the “vividness” of the phantom limb. Surgical amputation of limbs leads to far less persistent and vivid phantoms, while especially traumatic limb loss or previously painful surgical amputation “enhances” the phantom and makes it, simply put, more “real.”
This is attributed to “pain memories” in traumatic cases and greater attention paid to the limb, pre-operation, in surgical cases. Painful phantoms, cruelly, also seem to persist longer than non-painful ones.
Involuntary Phantom Limb Movements Are Very Common
It’s possible to “generate voluntary movements” of a phantom limb, such as making your phantom reach out grab something. But according to Dr. Ramachandran, sometimes, the phantom has a mind of its own, moving involuntarily. There are “quasi-voluntary” movements such as a phantom trying to break a fall, wave goodbye, or block a punch, for example. There are also totally involuntary movements such as clenching spasms or “the hand suddenly moving to occupy a new position.”
Phantom Limbs “Remember” Old Limb Pain
Removing a limb doesn’t necessarily remove any painful conditions that existed on that limb. Phantom limbs will “remember” the pain of say, a wrist injury, even long after the wrist is gone. There are even accounts of arthritis sufferers experiencing a “flare up” in their hands during cold weather. . . even though their hands were long gone.
This phenomenon also extends to other body parts: there are reports of “phantom menstrual cramps” after hysterectomy and phantom “ulcer pains” after a partial gastrectomy (removal of all or part of the stomach).
Leprosy Patients Who Lose Limbs Don’t Get Phantoms
A sort of sick “silver lining” to losing a limb via leprosy is that there won’t be any phantom pain—or any phantom feelings of any kind. This gradual loss of limbs, experts say, is phantom-free because the patient learns to “assimilate the stump into his body image” using “visual feedback.” In other words, they see it all go down.
There is, however, an interesting little “footnote” to this fact: if the leprosy patient has to have their stump amputated, the entire phantom limb is often “resurrected”—not just a “phantom stump.”
An “Illusion” Can Treat Phantom Limb Pain
Amazingly, a simple $5 mirror “illusion” has proven to be remarkably effective in treating phantom limb pain. When one of Dr. Ramachandaran’s patients complained of cramping in his phantom arm, Ramachandaran devised a weirdly simple treatment. Here’s how NPR describes it:
He placed a mirror in a cardboard box and instructed the patient to place his existing hand inside the box, next to the mirror. When the patient looked down at the mirror, the reflection of his existing hand stood in as a visual replacement of his phantom limb. The patient was told to imagine that the reflection was in fact the lost limb, and to practice clenching and unclenching his hand while looking in the mirror.
This simple little illusion proved surprisingly effective. This particular patient lost his phantom limb after two weeks of this treatment in what Dr. R called the first “successful amputation of a phantom limb.” Others, however, were not as fortunate: some patients reported “no effect whatsoever” and still others experienced “anatomically impossible positions” such as the hyperextension of a phantom finger.