522
Phantom Limb Pain Treated With Therapeutic Touch:
A Case Report
Eric D. Leskowitz, MD
ABSTRACT. Leskowitz ED. Phantom limb pain treated with
therapeutic touch: a case report. Arch Phys Med Rehabil
2000;81:522-4.
Phantom limb pain is a widespread condition that responds
poorly to conventional medical and surgical treatments. A case
report is presented of the successful treatment of phantom leg
pain in a 62-year-old man with peripheral vascular disease
using the complementary medical technique of Therapeutic
Touch. The clinical and research literature of Therapeutic Touch
is briefly reviewed, with regard to subjective outcome measures
like pain and anxiety, as well as to several objective measures of
physiologic function. The possible role of nonspecific factors
like placebo responsiveness or hypnotic dissociation in this case
are considered, as are the applicability of complementary and
alternative medicine to phantom limb pain, the neurologic
mechanisms that generate phantom sensations, and the possible
mechanism of action of Therapeutic Touch.
Key Words: Phantom pain; Therapeutic Touch; Complemen-
tary and alternative medicine (CAM).
娀 2000 by the American Congress of Rehabilitation Medi-
cine and the American Academy of Physical Medicine and
Rehabilitation
P HANTOM LIMB PAIN, a widespread syndrome that is
poorly responsive to traditional medical, surgical, or reha-
bilitation interventions, affects 50% to 70% of all patients who
undergo planned surgical or traumatic amputations.1 In only
10% to 20% of cases do the sensations of burning or crushing
pain respond to such treatments as opiate medication, neurotrans-
mitter modulation by means of GABAergic or serotonergic
medications, or spinal cord stimulation.2 It is estimated that
over 500,000 Americans today suffer from phantom limb pain.1
The American public now uses complementary and alterna-
tive medical therapies on an unprecedented scale. From surveys
of general medical populations, researchers have estimated that
30% to 50% of patients use these therapies,3 typically in
conjunction with standard medical treatments; recent surveys of
outpatient rehabilitation populations indicate similar utilization
rates.4 No reports exist in the conventional medical literature on
the use of complementary and alternative medicine to treat
phantom limb pain. This report describes a case of phantom leg
pain that responded well to an alternative therapy called
‘‘Therapeutic Touch.’’ This report addresses questions about the
applicability of complementary and alternative medicine to
phantom limb pain, about the neurologic mechanisms that
From the Pain Management Program, Spaulding Rehabilitation Hospital, Bos-
ton, MA.
Submitted for publication May 4, 1999. Accepted in revised form July 9, 1999.
No commercial party having a direct financial interest in the results of the research
supporting this article has or will confer a benefit upon the authors or upon any
organization with which the authors are associated.
Reprints will not be available from the author.
娀 2000 by the American Congress of Rehabilitation Medicine and the American
Academy of Physical Medicine and Rehabilitation
0003-9993/00/8104-5630$3.00/0
doi:10.1053/mr.2000.1764
Arch Phys Med Rehabil Vol 81, April 2000
generate phantom sensations, and about the possible mecha-
nism of action of Therapeutic Touch.
CASE DESCRIPTION
The patient was a 62-year-old retired plumber with phantom
pain who had undergone a right-sided below-knee amputation 4
years earlier to treat invasive cellulitis originating from a
nonhealing ulcer of the right foot. Shortly after the surgery, he
developed lancinating paroxysmal pain sensations in his miss-
ing extremity, which severely limited his functional status.
These pains typically ranged in intensity from 8 to 10 on a
self-reported visual analog scale (VAS), with 10 being the
maximum intensity. His treatment included various combina-
tions of short- and long-acting opiate medications, which
provided some pain relief (down to 6 on the VAS), but caused
unacceptable levels of daytime sedation. Tricycylic antidepres-
sants (amitryptiline, desipramine) were also somewhat helpful,
but numerous other antineuropathic pain medications and
therapies were essentially useless (gabapentin, clonazepam,
carbamazepine, intravenous lidocaine and oral mexilitene,
dextromethorphan, mysoline, capsaicin ointment and EMLA
cream, transcutaneous electrical nerve stimulation, ice mas-
sage, and ultrasound). His underlying medical condition was a
peripheral neuropathy related both to chronic alcoholism of 30
years’ duration and to adult onset non–insulin-dependent diabe-
tes.
The patient had already gained significant benefit from
participating in an interdisciplinary pain management program
that emphasized physical reconditioning and stress manage-
ment training, which included autogenics and progressive muscle
relaxation without self-hypnosis or transcutaneous electrical
nerve stimulation. By performing these self-management tech-
niques on his own, he was able to lead a more active life despite
the persistence of fairly severe pain, which he rated at 7 or 8 on
the VAS. His tolerance for outside activities was limited to 1
hour daily, even when pursuing his hobby of glassmaking.
Because of the persistence of the pain, he was willing to pursue
a course of nontraditional treatment.
His physical exam was essentially unremarkable. Neurologic
exam showed normal mental status, normal cranial nerve exam,
and adequate strength, motor tone, and bulk. Reflexes were
diffusely diminished, with no dystaxia. He had a well-fitting
externally strapped lower limb prosthesis with no visible
slippage; his stump exam was notable for absence of neuromas,
and well-healed surgical scars. He ambulated unassisted, with a
slightly wide-based gait. No electrophysiologic testing had
been done, as the patient had clear clinical evidence of both
small- and large-fiber sensory peripheral neuropathy.
The patient was given a brief explanation of Therapeutic
Touch, which was described as a widely used nursing interven-
tion with a mechanism of action that was not well understood,
but which was theorized to involve interaction with an electro-
magnetic field associated with the nervous system of living
organisms. He was ignorant about this technique, but receptive
to an empiric trial of it. 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
 PHANTOM LIMB PAIN AND THERAPEUTIC TOUCH, Leskowitz
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 recur-
rences 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.
DISCUSSION
The technique of Therapeutic Touch was developed in the
early 1970s5 to give nurses a nonsectarian method of transmit-
ting to patients the alleged healing qualities traditionally
attributed to practitioners of the spiritual practice called ‘‘the
laying-on of hands.’’ The technique has been taught to tens of
thousands of American nurses. The nurse first calms herself or
himself by meditatively focusing on the intent to be of service
to the patient. The nurse then holds her or his hands about 6
inches from the patient’s body to locate ‘‘blockages’’ in the
purported human energy field. The nurse then ‘‘rebalances’’ this
field by passing her or his hands over the affected region
without making actual physical contact.
Although a fairly large research literature on Therapeutic
Touch has been generated, most studies did not use a rigorous
research design; for example, many studies were uncontrolled
and descriptive, focusing on hard-to-quantify subjective symp-
toms without using blinded raters. Some double-blind studies
do suggest definite subjective benefits from Therapeutic Touch
(pain relief,6 anxiety diminution7 ), while two fairly rigorous
studies appear to suggest Therapeutic Touch–induced changes
in objective physiologic indices such as increased healing of
dermal wounds8 and alteration of cellular immune function.9
A recent, widely publicized study10 attempted to disprove the
existence of the so-called human energy field that Therapeutic
Touch purportedly alters or affects to the patient’s benefit.
Using an ingenious experimental protocol to test energy
sensitivity, nurse subjects in that study were unable to detect the
presence of the experimenter’s hands near their own palms at a
statistically significant rate, implying to the authors that the
human energy field did not exist. The study had no control
conditions and no randomization of subjects, blinded raters
were not used, and no clinical variables or outcome measures
were assessed—only the nurses’ ability to detect the experiment-
er’s proximate hand. Hence, the authors’ conclusion that
Therapeutic Touch is clinically ineffective was not supported by
the study’s data. That study’s research design must be further
refined before definitive statements can be made about the
existence of the human energy field or the therapeutic efficacy
of treatments based on its manipulation.
523
Nevertheless, the apparent effectiveness of Therapeutic Touch
in our case example has several potential explanations. Nonspe-
cific factors such as placebo responsiveness likely played a role,
since factors associated with the placebo response were present
in this case: the uniqueness and unexpectedness of the treat-
ment, the authority and confidence of the practitioner, and the
patient’s high degree of trust in the clinician.11 The patient’s
ability to generate his own guided imagery process to replicate
the effects of the Therapeutic Touch therapy suggests that he
may have been responding to hypnotic aspects of Therapeutic
Touch; a high degree of hypnotic suggestibility might have
helped him dissociate from his pain experience. However, even
when he paid close attention to his treated phantom foot in his
normal daytime state of consciousness, he could detect no pain
sensations, suggesting that hypnotic or dissociative mecha-
nisms were not at work during his posttreatment periods of
comfort. His hypnotic susceptibility, assessed at a 12-month
follow-up visit, was 2 on the Hypnotic Induction Profile of
Spiegel and Spiegel,12 which indicates a below-normal degree
of hypnotic responsiveness. Since the Hypnotic Induction
Profile is believed to measure a stable biologic trait rather than a
transient behavioral state, his hypnotic susceptibility was likely
low at the time of the Therapeutic Touch treatment, making
hypnosis a less likely mechanism of action for therapeutic
touch. Previous attempts by other researchers to use hypnosis in
the treatment of phantom pain have met with only modest
success.13
No current neurophysiologic models can explain how tactile
manipulation of the region in empty space that was formerly
occupied by a limb can affect central nervous system processing
and be perceived by the patient. The current neurologic
explanation for phantom phenomena, both phantom sensation
and phantom pain, invokes the concept of a cortical pattern
generator (a ‘‘neuromatrix’’) that maintains persistent neuro-
logic sensation in the absence of a peripheral stimulus genera-
tor.14 This idea has led to the development of at least one
promising approach to phantom pain prevention—‘‘pre-
emptive’’ analgesia administered before amputation surgery to
prevent the formation of this presumptive pain engram.15 The
existence of a subtle biomagnetic template underlying phantom
pain, as hypothesized by Therapeutic Touch theorists and
allegedly perceived by Therapeutic Touch therapists, remains
highly speculative at this time. However, this view of a human
electromagnetic ‘‘subtle anatomy’’ is also shared by other
schools within complementary and alternative medicine, includ-
ing traditional Chinese medicine (acupuncture meridians) and
yoga psychology (energy centers). Implications of recent
research in biomagnetism are discussed at length by Becker.16
CONCLUSION
Further exploration of the role of Therapeutic Touch in
treating phantom limb pain seems warranted for several rea-
sons. First, because of its potential efficacy and lack of adverse
side effects, Therapeutic Touch may be an important treatment
option for patients who are unresponsive to traditional ap-
proaches. Second, future efficacy studies could take so-called
‘‘mimic’’ Therapeutic Touch17 as a control procedure to elimi-
nate placebo and expectancy factors and to better understand its
clinical effectiveness. Third, Therapeutic Touch can easily be
transformed from an active procedure done to a passive patient
into a patient-directed method of pain control compatible with
the self-management philosophy of chronic pain rehabilitation.
Finally, further study of Therapeutic Touch treatment for
phantom limb pain may help to answer questions about the
pathophysiology of a puzzling neurologic disorder and about
Arch Phys Med Rehabil Vol 81, April 2000
524 PHANTOM LIMB PAIN AND THERAPEUTIC TOUCH, Leskowitz
the mechanism of action of a novel complementary medical
therapy.
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