Non-painful phantom limb sensations

Background. Phantom, or phantom limb (PL), or phantom amputee is a false sensation of the presence of a lost body part, a multifaceted and to date not fully investigated phenomenon that occurs after amputation of a body part. Up to 98–99% of amputated patients experience sensations in the lost body part soon after the operation: they feel warmth or cold, itching, pressure and even the position of the phantom limb in space. The most frequent painful PL form – phantom pain (PP), or phantom pain syndrome, occurs in 29–85.6% of patients. However, apart from the painful PL/PP form, phantom sensations (PS) as a more rarely described painless form of PL exists. Objective: To review publications describing the clinical picture, course of painless PL form – PS, compare PS with PP, and determine their relationship.
Material and methods. We analyzed literature sources aimed at describing painless PL available in the databases PubMed/ MEDLINE, Scopus, Google Scholar, OpenAlex, eLibrary, CyberLeninka as well as located in the Russian State Library and the State Central Scientific Medical Library. The search was conducted using the following keywords: “phantom limb sensation”, “non-painful phantom”, “painless phantom”, “natural phantom”, “telescoping phenomenon” in Russian and English.
Results. The prevalence of PS reported in the studies ranged from 32.4% to 90% among all amputees. The sensations of one amputee were shown to completely differ from those of another subject, obviously being related to individual reactivity. A comparative analysis of PS and PP was carried out, their similarities and differences were determined, and relevant relationships detailed; it was revealed that the division into PS and PP is conditional and both phenomena can alternate in one patient. Comparing PS with PP allowed to establish that PS magnitude and brightness can directly correlate with PP severity, with both clinical forms able to mutually transform. Physical and socio-psychological factors have been identified to be associated with PP. The relationship between loss and loss denial as well as underlying psychopathology in PS or PP development was shown.
Conclusion. Painless PL is not often described in the literature; therefore, gaining new knowledge on this topic and understanding by doctors regarding diversity of sensations after amputation may be useful both for informing patients about potential painful and painless course of postamputation period and for timely identification of pathological course behind natural painless PL, which may evidence about deep psychotization of amputee's personality.

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