Phantom limb research

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Case reports




Phantom Limb Pain and Therapeutic Touch™
(updated 12/14/09 --» What’s new? )

This page details the evidence in the literature regarding the effect of Therapeutic Touch therapy on phantom limb pain. These cases confirm M.G.’s report that when a massage therapist passes her hand over M.G.’s phantom hand during a massage, M.G. feels the “touch” as tickling and she giggles. In addition, they support the idea that the phantom limb in general is objectively real and acts as a field extending beyond the physical body, in which physiological sensations can be evoked by interaction with another person.

  1. Background
  2. Case reports
  3. Discussion
  4. References

Comments on our work are welcome! Please feel free to comment on our Discussion Group on the Self-Conscious Mind.

Robert and Suzanne Mays

What’s new?
  • 12/14/09 - added cases from Leskowitz, revised description of case from spring 1991
  • 11/25/09 - expanded page
  • 11/17/09 - started page


Therapeutic Touch (TT) is a form of energy therapy for balancing the energy flow in the body through observing and repatterning the patient’s energy field. Therapeutic touch was developed in 1972 by Dolores Krieger, a nursing professor at New York University. When administering treatment, TT practitioners hold their hands an inch or two above the patient’s body without making physical contact. The practitioner tunes into or “feels” the patient’s energy field with his/her hands and then manipulates the energy field, smoothing out the “disordered” field and channeling new energy into the patient’s body. Therapeutic Touch is thought to affect patients through the connection of energy fields within and immediately outside the physical body. The movement of energy stimulates internal physical mechanisms.

Treatment sessions typically last 5 to 20 minutes, but may take up to 30 minutes. The treatment protocol consists of a sequence of five steps (Sayre-Adams, 1993):
  • Centering — to focus attention on the patient and calm the patient’s mind, by disciplining attention, achieving calm and establishing receptivity
  • Assessing — to evaluate the patient’s energy field for irregularities, through subtle sensations and intuitive or somatic clues
  • Clearing — to facilitate symmetrical flow of energy through the patient’s energy field, by sweeping the hands above the patient’s body downward
  • Intervention or balancing — to assist re-establishing the order in the system and repatterning the energy field, by smoothing and balancing over areas where congestion and imbalances persist
  • Evaluation/closure — to verify the effects, through professional, informed and intuitive judgment, and to conclude the treatment
Phantom limb pain: A phantom limb is the vivid subjective experience that an absent limb (congenitally or via amputation) is present. Between 90% and 98% of all amputees experience a vivid phantom limb almost immediately after the loss. Within the first few weeks after amputation, as many as 70% of amputees also experience pain or discomfort in the phantom, usually intermittently but occasionally continuously. The pain generally diminishes over time and for some it disappears, but even after seven years as many as 50% of amputees continue to experience phantom limb pain (Bloomquist, 2001). Over time the phantom limb may shorten (“telescope” into the stump), generally accompanied by a reduction in pain. Phantom pain is more likely to occur in upper limb amputations, in above the elbow or above the knee amputations, and with amputations performed on the dominant arm (Cohen, Christo and Moroz, 2004).

There are several types of phantom pain: burning, electric current, throbbing, cramping, itching, cutting, twitching, stabbing, tearing, and crushing.

Preemptive treatment prior to amputation involves the use of an epidural (spinal) anesthetic blockade three days before surgery. The results have been positive in some studies but not others, so the effectiveness of preemptive analgesia remains controversial.

The treatment of postoperative phantom limb pain is difficult and has generally not been successful. Fewer than 10% of patients with phantom pain receive lasting relief from prescribed medical treatments. Phantom pain interventions and treatments include administration of anesthetics, electric nerve stimulation, administration of anti-depressants and anti-convulsants, stump revision and physical therapy in preparation for prosthesis, and psychotherapy (Manchikanti and Singh, 2004). Neurosurgical  techniques such as ablation or transsection of the relevant nerves in the stump, spinal cord, thalamus or cortex generally do not result in elimination of the phantom limb pain. Such procedures for the most part have been abandoned (Nikolajsen and Jensen, 2001).

Phantom limb pain and Therapeutic Touch: There have been at least a dozen anecdotal reports of the successful application of Therapeutic Touch in phantom limb pain treatment. Some of the reports are quite dramatic in the degree and speed of relief that was achieved. However, Therapeutic Touch is not 100% effective: sometimes nothing happens and sometimes patients need repeated treatments (Mason, 2002; Leskowitz, 2009). More research is needed before Therapeutic Touch can be recommended as a treatment for phantom limb pain (Natural Standard, 2008).

Case reports
A number of cases have been reported of the use of TT to treat phantom pain in amputees. The cases have a number of features in common.
  • Rupert Sheldrake (1995, 2002, pp. 152-153) quoted a report from Dr. Barbara Joyce, head of the graduate nursing program at New Rochelle College, New York, about using Therapeutic Touch to reduce pain and discomfort in two women with leg amputations:
In both instances patients reported that Therapeutic Touch used in the field of the missing limb reduces sensations of itching and pain. Although more clearly with one patient, but to some degree with the second, I was able to “feel” the phantom or missing limb and my estimation of its location in space corresponded with the patient’s “sensation” of its location.
  • Eric Leskowitz (2000) reported the case of a 62-year-old man who had undergone a right-sided below-knee amputation four years earlier and had developed suddenly recurring sharp, stabbing phantom pain shortly after surgery, ranging from 8 to 10 out of 10 on a self-reported visual analog scale (VAS). Various pain medications and therapies were ineffective except certain antidepressants and combinations of opiate medications. His pain level was typically 7 or 8 on the VAS and his outside activities were limited to one hour daily. The patient was given a brief description of Therapeutic Touch.
He sat on an examining table with both legs fully extended for the initial “assessment” phase of the treatment, which involved manual scanning of the purported energy field of his phantom limb. Even though his eyes were closed, he was able to sense the presence of the clinician’s hands in the region of his phantom limb. When the therapeutic process of distally stroking the “energy field” was begun, the patient described a sensation as though his pain were draining down his leg and out his foot. Within a matter of moments, he was pain free for the first time since his surgery (0 on the VAS). This period of comfort lasted several days, until the day before his next scheduled medical appointment. The night before this appointment, he was characteristically sleepless, and he felt that this stress caused a recurrence of his pain. Again, a brief treatment yielded complete pain relief (0 on the VAS), which again persisted until he next felt significant life stress several days later. He was then taught a self-treatment approach in which he could apply the Therapeutic Touch procedure to his phantom limb and gain similar benefits. At 6-month follow-up, he reported general absence of pain, which he rated as 0 to 1 on the VAS. He suffered occasional stress-induced pain recurrences that responded to his self-management process of Therapeutic Touch. He listened to an audiotape on progressive muscle relaxation and autogenic training about three times weekly. He was taking no pain medications, and developed more tolerance of his active lifestyle, which at 6-month follow-up included daily walks outdoors and daily work at his hobby for several hours at a time.
  • David Maginley (2002) reported the case of an elderly man who had undergone left leg above the knee amputation and experienced phantom pain in the absent foot, rated at 8 out of 10.
I explained the procedure, and he was ‘open to anything that would work’. Drawing the curtain, I encouraged the nurse to stay and observe, then centred and began my assessment. In my hands, I could feel energy flaring from his the head and stomach which in my mind’s eye seemed to scream ‘stress!’ His leg was fairly neutral, until I reached the amputated area. There the energy flared out, with what seemed like a static charge down to the missing foot, where it seemed to be particularly strong. Immediately, I began clearing and grounding.

“Oh, yes, that’s it,” he said. “I can feel that. Are you touching me?” I found the question fascinating, since there was no leg to touch! I could see the patient quickly relaxing. His body sank into the mattress; his breath deepened and he gave an audible sigh. He was obviously experiencing relief from the pain. Grounding the energy field through his missing foot seemed very effective, the energy moving quickly through left side of his body and out. Moving my fingers quickly, I pulled the energy out in strands, making sure to assist the flow as I stayed in touch with his field and let it lead.

“How’s the pain now?” I asked. “About 3 out of 10,” he replied. His voice was soft. I continued to work for more ten minutes, and he fell asleep. The nurse observing us was thrilled and amazed. “This is a lot better than narcotics!” she said.

The patient could not see what was happening during the treatment as he was lying down, his eyes were closed, and his head was turned to the right, away from the left leg. The pain returned a while later when the patient was awakened suddenly by another patient’s behavior but another treatment calmed the patient. After two more treatments, the phantom pain ceased completely. Maginley reported, “I could distinctly feel the limb’s energy field, and the difference in that energy after clearing and treating the area. The energy in the phantom foot was particularly pronounced, and this area was confirmed by the patient during the treatment.”
  • Paul Philcox and colleagues (2003) reported a single blind randomized controlled clinical trial involving 9 clients assigned randomly to a treatment group receiving TT, a placebo group receiving mimic TT or a control group receiving no TT. Subjective pain scores were recorded immediately before treatment, immediately after treatment and one hour after treatment. The pain scores improved significantly immediately after treatment in the TT group compared with the other two groups, and the reduction in pain scores persisted on hour after treatment in the TT group relative to the other groups but the difference was not statistically significant. (Our comment: only the summary of this study is available and the study appears to have methodological flaws, especially a very small sample size. Nevertheless, the observation of a difference using TT is suggestive.)
  • Eric Leskowitz (2001) related three cases (see also Leskowitz, 2008):
Joe was a 35-year-old cargo loader whose leg had been crushed in a work injury, necessitating an above-knee amputation five years before he presented to our clinic. His chronic phantom limb pain was only marginally responsive to a regimen of antidepressants and opiates. He did not benefit from cognitive-behavioral retraining and was offered a trial of TT, about which he knew nothing. During the assessment phase, there was a similar energy presence sensed by the practitioner in the region of his missing leg that was also felt around the remainder of this intact body.... At that moment, the patient reported sensing his phantom limb being touched. As the treatment continued, Joe reported that the pain sensations seemed to be draining out of the bottom of this phantom foot. Surprisingly, he asked for the treatment to be stopped before the pain could be completely alleviated, saying that he feared becoming pain-free because this would be proof to him that his leg was in fact missing. In other words, his pain served the psychological function of defending him against the shock that would come with full acceptance of his loss....

Ms. B was a 65-year-old widow whose severe diabetic peripheral vascular disease necessitated a below-the-knee amputation of her right leg.... Within hours of her recovery from surgical anesthesia, she developed phantom pain of ...two toes.... The pain was not responsive to multiple medications.... [After psychotherapy her depression lifted] but her pain persisted. More dramatic results came with the application of direct energy healing. She, too, was able to feel my hand as it moved along the phantom limb, and she also felt as though the pain was a substance that could be guided to drain out of her foot.. The sensation was so light and gentle that she described it as “blowing in the wind”... It was also accompanied by a vivid feeling of sky blue “relaxation” that flowed down her body, seeming to come from God before it moved down into her leg. As the phantom pain dissipated, she became more aware of the pain in her stump, and soon this too left. After our first energy healing session, she was pain free for the first time since surgery. However, the physical irritation of being fitted for a prosthetic leg and the emotional strain of a visit home led to a relapse of the pain. She then begain to receive daily Therapeutic Touch sessions from her primary nurse, and learned to observe that her pain followed a predictable pattern. When she was tired or feeling stressed (by worrying about the well-being of her agitated and delirious roommate, for example), her pain recurred shortly after each energy treatment. If she was well-rested and peaceful, she could be comfortable all day after treatment. By the time of her discharge, she had learned to administer Therapeutic Touch to her own leg, and planned to seek follow up from another physician/healer in her community.

Mr. C. was a 67-year-old man who underwent a right below-the-knee amputation 17 years before admission to our clinic, because of peripheral vascular disease. He had suffered alcoholic neuropathy in both legs prior to surgery, and this neuropathic pain persisted in his phantom. He responded dramatically to TT treatment, with the pain on the dorsum of his foot seeming to drain out within 30 secones of the onset of TT. Unlike the other two cases, neither he nor I sensed the enrgetic presence of the other's hand or foot during the treatment session. He slept uninterruptedly that night for the first time in years. His pain recurred when he returned for follow-up, but he was able to independently release it when he located a “drainage valve” near the ball of his phantom foot. Interestingly, this “valve” corresponded to the origin of the kidney acupuncture meridian, the so-called “bubbling well” that is a key intake point for life energy. Mr. C has not required further treatment since his initial course of 3 TT sessions.
  • In another case (personal communication October 17, 2009), an Advanced Practice Nurse worked in spring 1991 with U.S. servicemen amputees, using Reiki, an energy therapy similar to Therapeutic Touch. In her first case, a serviceman had lost both legs in a land mine explosion during the Persian Gulf War, one amputated above the knee and one below the knee. The patient was experiencing phantom limb pain and depression. The nurse did “sweeping” movements over the phantom limbs. The patient at the time had both eyes fully bandaged due to injuries around the eyes and facial lacerations from the explosion but could feel and identified correctly where the nurse’s hands were. The nurse could feel where the phantom limb was and “smoothed out” the borders and surface of the phantom limb. The patient felt immediate relief of the pain and his depression lifted. The pain returned somewhat after one day but after two more therapy sessions, the patient was pain free and remained so for the more than three months afterward that the nurse followed his case. The nurse later had similar results with a number of other amputees at Walter Reed Army Medical Center.


These case reports share a common phenomenology:
  • The therapist can feel the phantom limb as “present” in the expected location, sometimes having a distinctive “energy”.
  • The patient can feel the presence of the therapist’s hand in the phantom limb area that the therapist is working in, despite the fact that the patient cannot see what the therapist is doing (the eyes are closed, the patient is looking away or the patient’s eyes are bandaged).
  • The patient experiences immediate and dramatic reduction in the subjective pain.
  • Several treatments are required for long-term pain relief.
  • The patient’s pain relief persists but may be triggered by stress.
The evidence from Therapeutic Touch treatment of phantom limb pain, while mostly anecdotal, supports the ideas (1) that phantom limbs are objectively real and act as a field extending beyond the physical body, and (2) that physiological sensations can be evoked in the patient by interaction of the phantom limb with another person.

  • Bloomquist, T. (2001). Amputation and phantom limb pain: A pain-prevention model. AANA Journal, 69(3):211-217. (Reprint)
  • Bowser, M. S. (1991). Giving up the ghost: a review of phantom limb phenomena. Journal of Rehabilitation, 57, July, 1991. (Reprint)
  • Cohen, S. P., Christo, P. J., and Moroz, L. (2004). Pain management in trauma patients. American Journal of Physical Medicine and Rehabilitation, 83(2): 142-161. (Reprint)
  • Leskowitz, Eric (2000). Phantom limb pain treated with Therapeutic Touch: a case report. Archives of Physical Medicine and Rehabilitation, 81:522-524. (Reprint)
  • Leskowitz, Eric (2001). Phantom limb pain: subtle energy perspectives. Subtle Energies and Energy Medicine, 8(2):125-152.
  • Leskowitz, Eric (2008). Energy-based therapies for chronic pain. In Joseph F. Audette and Allison Bailey (eds.), Integrative Pain Medicine: The science and practice of complementary and alternative medicine in pain management (pp. 225-241). Totowa, NJ: Humana Press. (Preview)
  • Leskowitz, Eric (2009). Energy medicine perspectives on phantom-limb pain. Alternative and Complementary Therapies, April 2009, 15(2):59-63. (Abstract)
  • Maginley, David (2002). Therapeutic Touch and phantom limb pain. Therapeutic Touch Network (Ontario) Conference, Toronto, Canada, November, 2002. (Reprint)
  • Manchikanti, L., and Singh, V. (2004). Managing phantom pain. Pain Physician, 7:365-375. (Reprint)
  • Mason, Russ (2002). Alleviating pain with energy medicine: An interview with Eric Leskowitz, M.D. Alternative and Complementary Therapies, October 2002, 8(5):278-283. (Reprint)
  • Natural Standard (2008). Therapeutic Touch. (Reprint)
  • Nikolajsen, L., and Jensen, T. S. (2001). Phantom limb pain. British Journal of Anaesthesia, 87(1), 107-116. (Reprint)
  • Philcox, Paul, Rawlins, Lainie, and Rodgers, Lynne (2003). Therapeutic Touch for phantom limb pain. Cooperative Connection, 24(3):10-11. (Summary)
  • Sayre-Adams, J. (1993). Therapeutic Touch -- principles and practice. Complementary Therapies in Medicine, 1(2):96-99. (Reprint)
  • Sheldrake, R. (1995, 2002). Seven Experiments that Could Change the World: A do-it-yourself guide to revolutionary science. Rochester, VT: Park Street Press.

Copyright © 2009 Robert G. Mays and Suzanne B. Mays

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