Ghosts of the past – how the brain refuses to let go of lost limbs

It hurts. It itches. It burns. It tingles. And it doesn’t exist. Phantom pain is a sensation in parts of the body that have been lost due to amputation. The word phantom comes from the Greek for “ghost, apparition, illusion.” But despite its name, phantom pain is real: it complicates rehabilitation and prosthetics and exhausts a person mentally.

In the first year and a half of the full-scale Russian invasion, the number of amputations in Ukraine reached the scale of World War I. As a result of hostilities and Russian shelling, at least 50,000 Ukrainians have lost limbs, as previously reported by The Wall Street Journal, citing Ottobock, the world’s largest manufacturer of prostheses. About 80% of people with amputations experience pain in the lost limb, and almost all of them feel as if it is still there.

The nature of phantom pain remains poorly understood. The basis for understanding it is the somatotopic map — the brain’s internal image of the body, which it uses to control movement and process bodily sensations such as touch, pressure, pain and temperature. Each body part corresponds to a specific area of the brain; a significant portion is devoted to the tongue, lips and fingertips, which have the densest concentration of nerve endings.

After amputation, this map does not change immediately: the brain still “sees” the lost limb and continues to send signals to it. This is why a person may feel as if they still have an arm or leg, even though physically the limb is no longer there. This is how phantom sensations arise, and with them, phantom pain.

Methods of treating phantom pain

In March 2025, serviceman Eduard Kostetskyi was wounded and lost his hand. Months later, he still feels as if it is there: he can “move it,” “clench a fist,” but fully “straightening the fingers” is hard. Along with phantom sensations, Eduard is plagued by pain.

“I constantly feel numbness in my hand. From time to time throughout the day, I get shooting pains, and sometimes it feels like an electric current is hitting my fingers, or like they’re burning,” he says.

To get rid of the numbness for at least an hour, the soldier undergoes daily myostimulation — stimulating muscles with electrical impulses. He also does motor training — imagined movements with the amputated limb.

At the Tytanovi (Titians) Center in Kyiv, they use a computer program with augmented reality (AR) for this purpose. The patient sees themselves on the screen with a visually recreated limb. Clinicians attach sensors to the body to read movement signals, and the image of the limb on the screen responds to these impulses. In this way, the brain receives visual confirmation that the limb is there and can be controlled.

As Yaroslav Patsukevych, a biomedical engineer at Tytanovi, explains, after an amputation the neurons that controlled the limb switch to generating pain. The point of this training is to redirect the patient’s focus back — to controlling the limb. When the brain is busy flexing, extending or rotating the limb, pain recedes into the background.

Even without sensors, simply by observing the movements of the virtual hand and imitating them with a phantom limb, the patient gradually regains a sense of control over their body. This approach is based on the principles of mirror therapy, adapted to virtual and augmented reality technologies.

However, the method does not always work. Soldier Vitalii Voronovskyi, whose arm was amputated, recalls:

“They put a large mirror and a small mirror in front of me. Later, at Tytanovi, I trained on a computer, but it didn’t work for me. But many guys say it helps them,” Vitalii says. 

Doctors confirm that there is no universal approach. According to traumatologist Yevhen Abramovych, phantom pain is often masked by pain from neuromas — thickened nerve tissue that forms at the site of amputation. They cause similar sensations: “shooting pains,” burning, and tingling. That is why, before starting treatment for phantom pain, it is necessary to cure or remove the neuroma, sometimes surgically.

Only then do doctors select a combination of methods, individually for each patient. Myostimulation, motor training, and medication are just part of a broader arsenal. Other techniques include physiotherapy, massage, psychotherapy, Botox injections, nerve blocks, acupuncture, and even psychedelics.

Psychedelics in the treatment of phantom pain

While Ukrainian doctors are researching and introducing new methods for treating phantom pain, some remain unavailable because of legal restrictions. This primarily concerns therapy using psychedelic substances — in particular psilocybin, MDMA and LSD — which are currently banned in Ukraine. As far back as the 1970s, these substances began to be used in other countries to treat mental health disorders — anxiety, depression and post-traumatic stress disorder (PTSD). Today, says Tytanovi physician Yevhen Abramovych, psychedelic‑assisted therapy could help thousands of Ukrainian service members who suffer from phantom pain.

If a patient has PTSD, it intensifies phantom pain. Conversely, even the anticipation of phantom pain causes tension.

“If a patient is not getting enough sleep, is depressed, or feels fear, their sensitivity threshold decreases. The pain that the patient could rate at 7 to 8 points (on a 0–10 clinical pain scale), against the background of PTSD, can increase to 10,“ explains Abramovych.

According to him, when conventional methods do not help, wounded soldiers often try to “self‑medicate” the pain with alcohol and drugs. In many cases, he believes, this can be avoided by using psychedelic‑assisted therapy.

For such treatment, ketamine is currently the only psychedelic substance permitted in Ukraine, which has been used in ketamine-assisted therapy since 2018. During the session, under the supervision of an anesthesiologist and psychotherapist, the patient is given microdoses of the drug through an IV. Over the next 40 to 90 minutes, they are in an altered state of consciousness, which helps them work through psychological trauma with the therapist.

Military serviceman Vadym Sitarchuk underwent a course of ketamine therapy. After being wounded and having both legs amputated, he withdrew into himself: he hardly spoke and avoided communication even with those closest to him. His physical pain was compounded by emotional pain – depression, anxiety, and nightmares.

“Everyone told me I was closed off, wound up. I hardly spoke to anyone,” Vadym shares.

Vadym remembers his first session of ketamine therapy as the most difficult.

“I found myself in complete darkness, unable to see anything. It was scary. Time dragged on forever,” he recalls.

A psychotherapist was nearby to keep him from getting lost in the experience: supporting him, guiding him, suggesting next steps. In the next session, the darkness in Vadym’s mind began to lift — a faint light appeared, the outlines of a room, imagined objects in it.

“I was looking for some kind of box. The therapist said: look, maybe there’s a door somewhere. I searched, and it appeared. In the last session, I ended up in space and flew between planets. It was calm. Good,” the soldier smiles.

Tytanovi physician Yevhen Abramovych sums up: after an amputation, the brain needs to forge new neural connections — and ketamine therapy helps with that. In his view, when working with phantom pain it is essential to work with the patient’s consciousness, because that is where the pain takes root. Then, together with physiotherapy, medication and new technologies, more and more wounded people will be able to overcome pain, restore their connection with their bodies and return to themselves.

Text: Viktoriia Kalimbet
Photo: Mykhaylo Palinchak

Adapted by Jared Goyette

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