Treatment of phantom limb pain

Neuroplasticity and the "body map"

After amputation, the brain retains a "map" of the lost limb. The nervous system continues to receive and generate signals that the brain interprets as pain, spasm, "twisting" or "squeezing" of the phantom hand or leg. This is not an "imaginary" pain but a real state of the nervous system.

The goal of treatment is to gently retune this map, giving the brain new adequate movement and sensory signals so that phantom pain decreases and stops interfering with life.

Risk factors and comorbid conditions

Phantom pain is more common after severe trauma, multiple surgeries, prolonged intense pain before amputation, and when combined with PTSD, anxiety, depression and chronic stress.

That is why we work not only with the pain symptom itself but also with the emotional state: traumatic memories, pain anticipation anxiety, sleep disturbances and bodily tension.

Classical mirror therapy

Mirror therapy is a method in which a mirror is used to create a visual illusion of the presence of the missing limb. A person performs movements with the intact limb, sees them in the mirror and, as it were, "returns" movement to the phantom part of the body.

This helps to reduce phantom pain, spasms and unpleasant sensations by reorganising connections between the visual cortex, motor cortex and somatosensory system.

Extended Max Ortiz Catalan method

The Max Ortiz Catalan method extends mirror therapy with virtual and augmented reality technologies and the use of myosensors. Sensors record electrical activity in the residual limb muscles, and the computer system converts these signals into movements of a virtual limb on the screen.

In this way, a person sees how "their" virtual arm or leg moves in response to their own muscle impulses. This creates powerful feedback for the brain and helps to "rewrite" phantom pain, reducing its intensity and frequency.

Virtual and augmented reality, myosensors

The use of VR/AR makes it possible to create individual movement scenarios, games and tasks in which the virtual limb participates in actions (grasping objects, moving through space, etc.). Myosensors capture the intention to move, even when it is impossible to perform it in the physical body.

This format is especially useful for people for whom standard mirror therapy has had limited effect, and for those who are motivated to actively participate in the process and train imagined movements.

Mirror therapy protocols: for clinicians and patients

We also recommend a detailed video explaining mirror therapy protocols and an extended approach to working with phantom limb pain. The video at the link below discusses how to select exercises, what to pay attention to when working with a patient, which mistakes can aggravate pain and which strategies help gradually decrease the intensity of phantom sensations.

This resource can be helpful both for clinicians looking for practical guidance on organising mirror therapy, and for patients who want to better understand what they are doing during the exercises and why.

Watch the video on mirror therapy protocols (YouTube)

YouTube playlist on Max Ortiz Catalan method

For those who want to understand the evidence-based approach to treating phantom limb pain in more detail, we recommend a YouTube playlist about the Max Ortiz Catalan method. The videos explain how the system works, present research results and show patient examples.

Watch the Max Ortiz Catalan method playlist on YouTube

International #FightPLP initiative

For those who read English and want to explore phantom limb pain in more depth, we recommend the #FightPLP initiative. This is a non-profit, volunteer-based project led by scientists and clinicians, providing updated, science-based information on PLP, its mechanisms and available treatments worldwide.

The website explains the difference between phantom limb pain and stump pain, highlights the role of neuroplasticity, and reviews modern rehabilitative and neuromodulatory approaches, as well as the importance of educating both patients and healthcare professionals. It is a valuable resource if you want to understand how contemporary science looks at PLP.

Visit the #FightPLP website

Comprehensive approach

It is important to understand that even the most advanced technologies work best as part of a comprehensive approach: taking into account medication, rehabilitation, and psychotherapeutic work with trauma, PTSD, anxiety and depression.

During the consultation we discuss which elements of the protocol are suitable in your case and how to combine them with current treatment and rehabilitation. When planning, we rely on up-to-date scientific evidence (including the work of Max Ortiz Catalan and initiatives such as #FightPLP), but always tailor decisions to the individual person, their nervous system and their daily life.