SCHENECTADY — David Milavec was driving to his sister’s house in Scotia early the evening of Sept. 9 when he lost control of his motorcycle and crashed.

“I lost my left leg above the knee,” said Milavec, 46, an engineering manager for Bechtel Plant Machinery in Schenectady. “The details are unknown. I don’t remember a thing about the accident.”

Besides getting used to losing his leg, Milavec has had to learn to live with phantom limb pain — pain appearing to come from where the amputated limb used to be.

“I’ve had it from Day One,” said Milavec. “Some days, it feels like it’s asleep and it gets all numb and tingly. Other days, it’s worse. It feels like someone is driving nails into your leg or trying to saw your toes off. It’s very intense.”

For decades, doctors believed this post-amputation phenomenon was a psychological problem, but experts now recognize a physical cause for this pain, and that it actually originates in the brain.

For some people, phantom pain gets better over time without treatment. For others, managing phantom pain can be challenging.

“The doctors have given me medication to try to minimize and control the pain as best they can,” said Milavec. “For some people, it stays with them forever. For others, it goes away in months or years. I don’t know where I’m going to fall in that spectrum.”

Brain playing tricks

Most people who have had a limb removed report that it sometimes feels as if their amputated limb is still there.

“It’s often a sensation of itching or tingling or just a funny feeling,” said Dr. George Shelton, a physical medicine and rehabilitation specialist at Sunnyview Hospital and Rehabilitation Center. “Sometimes after a leg amputation, people will feel like they have to scratch their foot in the middle of the night, but that is not a painful sensation.”

Shelton, also director of the Amputee Inpatient Rehabilitation Program at Sunnyview, said a smaller group of amputees, between 20 percent and 40 percent, have phantom limb pain.

What they’re feeling

Symptoms of phantom limb pain include:

-- Onset within the first few days of amputation.

-- Tendency to come and go rather than be constant.

-- Seeming to come from the part of the limb farthest from the body, such as the foot of an amputated leg.

-- May be described as shooting, stabbing, boring, squeezing, throbbing or burning.

-- May be triggered by weather changes, pressure on the remaining part of the limb or emotional stress.

“Many people describe a stabbing type of pain or electrical shock sensations,” said Shelton. “Others complain of a burning sensation. And there are some, especially those who experience traumatic amputations such as losing an arm in a factory or farm machinery, who complain of a grinding sensation like they feel their flesh is tearing. The important thing to note is that no two cases are exactly the same.”

While the exact cause of phantom pain is unclear, it appears to originate in the brain. After an amputation, the nerves that used to serve that limb apparently “rewire” themselves, which remaps the brain’s circuitry.

“It’s not extremely well understood,” explained Shelton. “And there is no one treatment that works for everyone.”

Although there is no medical test to diagnose phantom limb pain, doctors can identify the condition by talking to patients about their symptoms.

“Many times, the pain comes and goes,” said Shelton. “Sometimes, it’s worse at night, and people have trouble sleeping. Other times people have trouble during the day. A smaller number of people have pain around the clock.”

Many times, the pain lasts for a short time, but Shelton said he has treated Vietnam veterans with amputations who still have phantom limb pain.

Relief can be hard to find

Finding a treatment can be difficult.

“One of the simplest things that is often helpful is to have the patient look at their amputated limb and to rub the end of the limb, once the surgical wounds heal completely,” said Shelton.

Some researchers report that using mirror therapy, where the patient looks at the intact limb in a mirror and tries to visualize the other limb being there, works for some people.

“Sometimes in the rehab setting, when we have people on crutches or a walker, we will have them look at themselves in a full-length mirror, so they can visualize what their limb looks like when they are up and about,” said Shelton.

Although there are no drugs specifically for phantom limb pain, doctors often use one or more different medications in an effort to come up with a combination that works best.

Opioid medications such as codeine and morphine may be an option for some people. However, these drugs have side effects such as constipation or sedation, and are usually not prescribed for long-term use.

“We also use an alpha blocker that works in the spinal cord in the brain called clonidine,” said Shelton. “That helps block some of the abnormal pain signals, but it doesn’t work for everyone.”

Some antidepressants and anticonvulsants — epilepsy drugs such as neurontin — also work in some people.

Some people also use transcutaneous electrical nerve stimulation, a device that sends a weak electrical current via adhesive patches on the skin near the area of the pain.

Some people have surgery called stump revision in which the ends of the nerves are cut, but that does not always work either.

“Many people tell me, if it’s a leg, when they put their artificial prosthesis on, and they start walking that it often helps them,” said Shelton. “But there are a few who say their pain is worse with the prosthesis.”

Despite the pain, Shelton said most people are able to get an artificial limb, get up and get moving.

“Phantom limb pain does not happen to the majority of patients,” Shelton stressed. “But when it does, it can be very distressing.”