"Phantom limb" pain has been recorded almost as long as people have been losing limbs and surviving. As we can see on the motor cortex, specific areas function to map out specific parts of the body. Losing a part of the body doesn't necessarily stop the cortex from continuing to "map" the missing part, adding a slight twist to Korzybski`s, "the map is not the territory."

Whilst it is common to refer to phantom limbs, "phantom" breasts, penis's, ears and other "phantom" bodily parts have been reported in patients who have undergone removal of these same parts.

Whilst not all amputees will experience phantom limb pain, there is evidence to suggest that the majority will at least initially continue to perceive the body part as still being present in some form.

For example, one patient of mine required a "bed cradle" prior to amputation to raise the bed linen off her painfully ulcerated legs continued to require the "bed cradle" for at least a week post surgery, lest she see the sheets rest upon her phantom ulcerated leg, causing severe pain.

Previous attempts at eliminating the phantom pains involved surgery to remove another inch or two from the affected limb/stump or even cutting through the relevant nerve root emerging from the spinal cord. These methods are very rarely found to be effective and generally end up with a surgical "game without end" in a manner described by Ramachandran as "chasing the phantom."

Patients with this pain will generally refer to the pain being in the spatial location of where the limb would have been or may even continue to experience a deterioration of the limb with an accompanied increase in pain. Curiously, the phantom limb may be painless at first only to develop pain as the phantom limb begins to develop contractures, particularly if the limb was paralysed prior to amputation.

As a generalization, there is less likely to be phantom pain following amputation if the patient is given sufficient analgesia for a 1-2 week period prior to the surgery. Conversely, the greater the pain in the period immediately prior to surgery, the greater the pain is likely to be post surgery.

NLP Case Study.

I was called to see a lady on a medical unit who had suffered a compound fracture of her femur, which has subsequently become grossly infected resulting in necrosis of the limb and necessitating amputation. The injury had occurred whilst as an in-patient in a neighboring hospital for an unrelated problem and two of the nursing staff were held to be negligent with regards to the incident that precipitated injury. The unfortunate patient had been transferred to a different hospital whilst litigation was pursued. The patient held a considerable amount of hostility towards the staff involved and was devastated by the injury and loss of her leg. She has also suffered a minor left sided CVA (stroke) secondary to the fractured femur. By the time of contact, the deficits from the CVA had mostly resolved. The patient was continuing to require high doses of morphine for her "phantom limb pain".

Method: The patient was asked to close her eyes and describe her healthy hand, which was positioned cataleptic in front of her face. The submodalities were elicited and slight changes in submodalities were suggested as a preliminary "trial run" to later change work. The submodalities of a memory from a distant and unpleasant time were elicited and a submodality swish demonstrated. A representation of a good and pleasant occasion was elicited and submodalities elicited and "tweaked" and positive state anchored and reinforced.

Next step, the representation and submodalities of the healthy limb were elicited and compared to that of the hand, which remained cataleptic in its initial position in front of her face. Note that at this point, the session was interrupted by the surgical team on their "rounds" who made a brief examination of the stump and exchanged a brief communication with the patient, who replied normally and to the satisfaction of the surgeons. During this time, the only evidence of trance was the cataleptic hand which did not move and went unnoticed by the surgical team.

Elicitation of the "phantom leg" representation and submodalities provided a shift in state and submodalities were significantly different. This representation was larger, misshapen, confused and full of sounds of screaming. The content of the representation reflected an associated movie of the incident in which the leg was initially fractured. The revulsion expressed by the patient was the appearance of bone through her skin and the hitherto unknown detail that the patient had tumbled from a filled commode and her broken leg had been brought into contact with said contents. This "movie" formed an unpleasant and endlessly playing movie loop.

With this turn of events, the patient was associated into a neutral state and a double dissociation technique used to dissociate her from the traumatic events. With the representation of this event de-potentiated, a submodality and content swish pattern was carried out, swishing the submodalites of the damaged leg for a representation of how the leg/stump would appear once it had fully healed.

This entire procedure, including time for interruption, lasted approximately 20 minutes.

The patient reported an 80% reduction in her discomfort.