Increasing phantom limb pain as a symptom of cancer recurrence

Previous studies have shown that phantom limb pain following major amputation reaches its greatest severity 2 to 3 weeks following amputation; it then gradually diminishes over subsequent months and years. Transient episodes of severe phantom limb pain are sometimes temporally related to specific activities such as urination, sexual intercourse, or local pressure applied to the amputation stump. Also, neuroma formation may be associated with transient episodes of increased discomfort usually associated with the application of local pressure. Phantom limb pain progressively increasing over an extended period of time has not been previously reported. The authors observed phantom limb pain of increasing severity to be associated with locally recurrent extremity sarcoma in two patients. In both patients increasing phantom limb pain was the first indication of recurrent cancer and led to radiologic studies and biopsy which confirmed the diagnosis of recurrent disease. It is suggested that phantom limb pain of progressive increasing severity may be a symptom of locally recurrent cancer in an amputation stump.