Having to have a limb amputated is a significant trauma, and one that would certainly be difficult enough to deal with all on its own. But for 64% of individuals who have had a lower limb amputated, phantom limb pain also comes with the territory. Phantom limb pain (PLP) is defined as pain perceived in a body part that no longer exists in physical form, and for many people, it can be severe and persistent. Clinicians and researchers still wrestle with understanding exactly why PLP occurs and how best to relieve it, but emerging studies make it clear that nonpharmacological approaches deserve attention.
Until recently, treatments such as mirror therapy, graded motor imagery, and sensory feedback training have dominated the clinical discussion because they appear to modify how the brain perceives the missing limb and the signals it sends about pain. These interventions are grounded in the idea that the nervous system, especially the brain, plays a central role in sustaining PLP through maladaptive neural reorganisation. Current expert opinion supports a range of non-drug strategies, although the quality and consistency of evidence vary widely.
So given the prevalence of PLP in amputees, and given chiropractors care for the nervous system by checking and adjusting subluxations thus assisting the body in more accurately perceiving and adapting to its environment, its reasonable to ask the question, “what about chiropractic?”
A recent clinical case reported in the Journal of Contemporary Chiropractic has highlighted this possibility, when a patient undergoing chiropractic care for low back pain experienced a notable and somewhat unexpected reduction in his phantom limb pain. (This is the first time such a case has been documented in case report form, though two prior cases are known and were presented in poster form at a chiropractic conference in 2005.)
A novel case begins
The case report in question covers the management of a 66-year-old man with a below-knee amputation on the left side. He had been living with phantom limb pain, which he described as burning and stabbing sensations in the absent foot, for approximately five years. These sensations had started just days after his initial amputation. He originally presented for care for ongoing low back pain and radicular pain in the residual limb.
His medical history was complex, with Type 2 Diabetes, chronica renal disease, diabetic ulcers, neuroarthropathy surgeries, kidney and pancreas transplants and end-stage renal disease in addition to the amputation.
At the start of care, his pain was significant. On standard pain rating scales. he scored 8 out of 10 for pain intensity and showed substantial functional impairment. This pain was aggravated with standing, walking, and even sleep, thus creating an enormous impact on his quality of life. Pain medication reaped only partial relief.
As obvious, you can’t adjust a limb that isn’t there. Thus, chiropractic care including lumbar long axis distraction and myofascial release was the care modality. Long axis distraction is a technique aimed at decompressing the spine, thus relieving pressure on nerve roots. Myofascial release targeted at the muscles of the lower back and hip aim to reduce tension and improve tissue mobility. It should be noted that these treatments are commonly used by chiropractors to address mechanical low back pain and radicular symptoms, but they are not routinely applied for neuropathic conditions like PLP.
At its heart, chiropractic care is about checking and adjusting subluxations, with the concept that optimal neurological function means that the body and brain can adapt better and do what the body does best – self-heal and self-regulate. In this case, care was targeted at the areas of the spine the chiropractor had detected as needing adjustments. What happened next was unexpected.
Unexpected Phantom Pain Relief
Around the fifth visit, the patient reported something remarkable: two weeks of complete relief from his phantom limb pain. This was not an expected outcome of the chiropractic care he was receiving, and neither he nor the chiropractor had specifically targeted the phantom pain with dedicated interventions.
Unfortunately, the patient’s insurance limitations meant he discontinued care at the sixth visit. At a later follow up, it became clear that he had sustained benefits when it came to low back pain and function, but the phantom limb pain after chiropractic care ceased.
This provides some interesting insight, though the isolated case means we have more questions than answers: would sustained chiropractic care have prevented a resumption of pain? Would others have a similar effect? Chiropractic care has been known to improve joint position sense. Has this effect led to an improved sense of body awareness thus affecting phantom limb pain? Chiropractic has been shown to impact pain processing; was that a factor here? Only more research will show the answers here.
Still, the case may offer hope to sufferers.
Understanding the Possible Mechanisms
To put this case into context, it helps to understand what we know about PLP’s neurobiology. Phantom pain is increasingly seen as a neuropathic condition associated with changes in the brain and spinal cord, including what researchers describe as maladaptive cortical reorganisation. When the brain loses input from the amputated limb, it may reorganise itself in a way that inadvertently sustains pain signals.
Traditional non-pharmacological treatments aim to correct this mismatch between expected sensory feedback and reality. For example, mirror therapy provides visual feedback that helps the brain recalibrate its perception of the missing limb. Meanwhile, graded motor imagery works on imagined movements to retrain cortical maps.
We are increasingly understanding the impact of chiropractic care on sensorimotor integration, neuroplasticity, cortical drive and more, which shows that chiropractic care actually can influence central nervous system activity. Techniques like long-axis distraction may reduce nerve root irritation, potentially altering spinal cord excitability. Soft-tissue work may modulate afferent input, affecting how the nervous system processes pain signals. In some models, this might influence central sensitisation or the balance of descending inhibitory pathways that dampen pain perception.
In this case, the reduction in PLP during a period when spinal irritation was also reduced invites speculation about shared neural pathways or a connection between mechanical spinal input and central pain processing. The fact that phantom pain improved when low back pain improved suggests a potential interplay between musculoskeletal and neuropathic pain systems, a line of inquiry that deserves more rigorous study.
This case is not a proof that chiropractic care cures phantom limb pain. Single case reports cannot establish cause and effect. There are many reasons a patient’s symptoms might wax and wane, including natural variability, placebo effects, changes in activity, or psychological factors.
However, it raises important questions, and more importantly, possibilities.
For chiropractors and other clinicians, this case underscores the value of being open to complex interactions between body and nervous system. It invites us to think not just in terms of isolated symptoms but in terms of interconnected networks of structure and sensation in an incredibly intelligent nervous system.
References:
Nisler J, Bowe-Fisher V, Gogineni V, Kirk E. UNEXPECTED PHANTOM LIMB PAIN RELIEF WITH CHIROPRACTIC CARE: A CASE REPORT. JCC. 2026;9(1):102-106.
