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Your Brain and Phantom Limb Phenomenon

Why do we feel Pain?

Pain is a physical response which acts as an alert system. Put simply, feeling pain tells us there is something wrong within the body. It is a protective system of sorts. It alerts us to dangers to ensure we do not repeat behaviour or actions which are damaging to the body. If it hurts to do something you generally do not continue doing it.

Phantom Limb Pain

It is very common for people with amputated limbs to sense pain in the limb that is no longer there. This illusionary pain has intrigued researchers for a number of years as to how the pain is sensed and why. There are no pain receptors present to send the usual signals to the brain from the limb that there is physical pain, yet at least 90% of amputees experience phantom limb pain.

Research by Ramachandran in the 1990’s suggested that those who had paralysis in that limb before it was amputated experienced the most severe phantom limb pain. He suggested a theory based on the idea that when they tried to move their paralysed limb, their brain received sensory feedback that the limb was unable to move. This feedback continues even when the limb is no longer present. This evidence along with an understanding that children born without limbs also experience phantom limb sensation leads experts to believe that the perception of our limbs is hard-wired into the brain.

How do we sense Pain?

Pain is all to do with the central nervous system in the body which is comprised of our brain and spinal cord.

  • tiny pain receptors called nociceptors are contained in your skin all over your body
  • each receptor ends in a neurone which forms the ending of a nerve cell
  • these are connected by nerve fibres directly to the spinal cord
  • When pain receptors are activated, an electrical signal is sent up these nerve fibres, through the collective peripheral nerve, from the point of pain origin and into the spinal cord

Within the spinal cord these electrical signals are transported by neurotransmitters (chemical messages) from nerve cell to nerve cell across synapses or the junctions between the cells.

Once these neurotransmitters reach the brain they enter into the thalamus.

The thalamus acts as a junction box where nerve signals are sorted and fired off to the somatosensory cortex regarding sensation, the frontal cortex regarding thinking and the limbic system regarding emotional response.

When damage is detected, the nociceptors fire pain signals to the brain via the spinal cord and will continue to do so while the damage is present.

Once the damage has been fixed or healed these nociceptors stop firing and the pain we experiences ceases. In some cases, they do not stop activating which can result in long term pain conditions.

Our neural networks are a web of nerve fibres sending signals around our body

Our neural networks are a web of nerve fibres sending signals around our body

The Nervous System

Our nervous system is an incredibly complex web network of wiring that fans out through your spinal column and across into all areas of your body.

It is this network that transports signals, including pain signals into the brain and sends responses back to different parts of your body. This is an automatic and very fast process with signals passing in and out of the brain through this network in fractions of a second.

It is a completely unconscious process, the mind is totally unaware of this occurring and it is not something we have any conscious control over.

Pain and Your Brain

Your brain itself is a mass of white and grey matter and does not contain pain receptors, however your scalp and the covering around the brain which protects it does. Note your brain is a physical mass but within that we have the conscious mind which responds and reacts to physical experiences such as pain. Part of the brain’s role in pain reception is to understand why the pain receptors have activated. This information gets submitted to your memory and will be compared to previous memories of similar reactions. The thalamus within the brain has this role.

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The thalamus can be thought of as the emotional centre of the brain where feelings and emotions are operated from and associations between feeling and emotions can be connected to pain. This in itself can create a physical response i.e. you may feel nauseous, your heart rate may increase, you may begin sweating. This is where the brain and the mind overlap.

The Theory of Pain

The most popular theory on how pain can be dealt with is the ‘gate theory’. This is based on the idea that there is a gate like system within the spinal cord where nerve signals go first when pain receptors are activated at the pain site. If the gate opens the signals will continue onto the brain, if the gate closes it blocks the signals from going any further.

This theory was suggested by Melzack and Wall in 1965 and they suggest such pain signals can be increased, decreased or even stopped within the spinal cord through this gate system before even reaching the brain and the various responses that come as a result.

Phantom Limb Pain and The Brain

It is thought that phantom limb pain is caused by your brain continuing to receive signals from the nerves that originally carried signals from the limb, or in the case of being born without a limb, were they would have carried the signals.

The brain does not recognize amputation very well. As far as your brain is concerned your limb is still there and it needs to learn that it has in fact been removed. Over time the brain does begin to recognise the limb is no longer present and reroutes the signals. However for some, this never fully completes meaning they have this pain for a long time and it can be very difficult to treat.

People can experience pain in the area of the amputated limb including different sensations such as tingling, cramping, shooting pain and sensitivity to heat and cold.

The Mirror Neuron

An Italian scientist in the 1990’s, Giacomo Rizzolatii, discovered nerons within the brains of macaque monkeys activated both when the monkey reaching out to grab something and when the monkey watched another monkey reach out. These findings were later replicated in humans, indicating that visual perception may be much more important within the sensation of movement than we first thought.

An amputees's experience of phantom limb pain

Ramachandran used this idea to test the effect of using mirrors to trick the brain into thinking the phantom limb was still present and could be controlled. When used with human subjects suffering phantom limb pain, he found many were relieved of their symptoms in the phantom limb.

The use of a mirror tricks the brain into believing an amputated limb is still present through visual information

The use of a mirror tricks the brain into believing an amputated limb is still present through visual information

The brain, it is believed, is tricked into thinking the limb is present through the visual information it receives from the reflection of the opposite limb in the mirror. Ramachandran named this treatment Visual Feedback Therapy (MVF).

Further evidence has been found in recent years for the effectiveness of using mirrors as treatment for phantom limb pain. A US medic, Dr Jack Tsao, used the technique with 22 amputee patients and found over the course of 4 weeks all patients reported a decrease in pain levels. Furthermore, it has been found those who use a prosthesis can also lower the levels of pain from the phantom limb. Again the visual feedback going to the brain suggests the limb is present which appears to intervene with the confused messages from the nervous system which are causing the original pain.


While our understanding of pain receptors and nerve signals is quite advanced, a different approach is required when pain is being felt from a limb which is no longer there. Visual perception is clearly very important within the phenomenon of phantom limb pain and can interfere with the confusing nerve signals the brain receives when a limb is amputated. the success of using a simple mirror to treat such pain is a considerable breakthrough for amputees struggling with this type of pain. Our brains are complex but clearly they can be tricked and the more advances we find in psychology and medicine, the more control we may be able to gain.

© 2015 PsychGeek


PsychGeek (author) from UK on February 17, 2015:

Thank you pstraubie48, I am pleased you enjoyed the article and found it interesting!

Patricia Scott from North Central Florida on February 17, 2015:

This article is very interesting. I have always been fascinated by this phenomenon. After reading this I have a clearer understanding of this topic.

Angels are on the way to you today.

Voted up++++ and shared

PsychGeek (author) from UK on February 16, 2015:

Hi Carol, that is a very good question. It must be extremely difficult when all your feelings and sensations are telling you your limb is there when in reality it isn't. I was surprised when researching this topic that this can happen, as you assume the brain would 'know' but clearly not. I do hope more research comes out in this area, if only to be able to explain why this happens. Thank you for reading and sharing your thoughts!

Carol Houle from Montreal on February 16, 2015:

Perhaps the mind could be temporarily fooled by a mirror image, however what does one do when the mind believes the limb is there and one attempts to stand up? My mother sometimes thinks her leg is there. She feels stabs, tightness where the leg is severed, but also aching pain in the phantom leg.

Good for you. This is a complex subject that needs further exploration.

Mara Alexander from Los Angeles, California on February 15, 2015:

I enjoyed reading it Psych, thank you for writing it.

The pain for him was severe, and he took morphine for many years, and a nerve pain pill called Gabapentin, the latter one relieved all the itching caused by the damaged knee. Itching is a type of pain that can drive you crazy

Walking with a prosthetic is very hard too. I guess it feels the same as it would if you walked around on your knees all day

Thanks again Psych

PsychGeek (author) from UK on February 15, 2015:

Hi Monkeyshine75, thank you for reading and sharing your thoughts and the vote of course! From what I understand, phantom limb pain can be very severe and it is hard to treat. It must so difficult to deal with this type of pain. At least for some this mirror therapy does appear to work and provide some relief which I think is a great step forward. Hopefully it is something that can be expanded on in the future. Thanks again!

Mara Alexander from Los Angeles, California on February 15, 2015:

My grand-dad got his lower right leg blown off after he stepped on a mine, when he was fighting during the Vietnam war. He had not only phantom pain, but itching, and warmth in his leg. He experienced a lot of discomfort from it up until the day he died. I guess they didn't know about this technique during his day, though I wish they had.

I can see how fooling the mind would work at least a little.

I think the doctor explained that the ends of the nerves are damaged during injury to the body, causing the pain, and itching.

This is a great hub that many vets need to read so I voted it up

PsychGeek (author) from UK on February 14, 2015:

Hi Stewart, thank you for such lovely comments! I am pleased you enjoyed the Hub. I think it helps a little to know how pain works when we are in pain, somehow having this understanding makes it a little better!

Stewart Guy on February 13, 2015:

This is an awesome hub, voted up. It is explained clearly how we feel pain, whether it is from an amputated limp or disease pain. The human body and brain is truly remarkable and it is fascinating that a mirror box can fool the brain through the visual. Love reading you hubs, they are always so interesting. Keep up the great work.

PsychGeek (author) from UK on February 12, 2015:

Tsao's work was the only clear research I found, however I assume there must be more people working with this as it seems to have such potential for a non-medical treatment. From what I understand if phantom limb pain continues 6 months or so after amputation, it can be severe and very difficult to treat in the standard medical way with pain relief. The use of mirror boxes for some could really make a huge difference! Thank you Kulbree, for reading and commenting!

Kulbree on February 11, 2015:

Bah! Another great one. I wonder as you did research on this topic, did you find any follow up to Ramachandran's work? In addition to the Tsao research, I would love to see more study on this topic. Probably hard to fund research into a non drug related treatment, I would guess.

PsychGeek (author) from UK on February 11, 2015:

Thank you Sandra! Our body certainly is one of the most fascinating topics. How it works and how it can go wrong, particularly concerning our pain mechanisms really is a remarkable thing.

Sandra from Bucharest on February 10, 2015:

This machinery that our body is still shows its secrets. Very interesting post! Congratulations!

PsychGeek (author) from UK on February 10, 2015:

Thank you Samprita, that is so very kind of you!

Dr. Samprita Sahu from Indore, India on February 09, 2015:

Your hubs are interesting as always!!! Love reading them... Voted up!!!

PsychGeek (author) from UK on February 09, 2015:

Hi Catherine, thank you for such kind words and vote and share! I learnt a lot doing this Hub and thought it would be useful to include what I had learnt on how pain works....I'm hoping this will help next time I'm in pain by knowing why! Thank you again for reading and commenting!

Catherine Giordano from Orlando Florida on February 09, 2015:

This is an amazing hub. It is about so much more than phantom pain; it explains why and how we feel pain. The human body is so complex. Voted up and shared.

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