Management of Phantom Limb Pain A Review

There are two types of pain after limb amputation, residual limb pain (RLP) that is pain localised on the stump, and pain perceived by the patient on the area of the missing limb which is called phantom limb pain (PLP). The prevalence of phantom limb pain remain high; several studies reported 50%-80% of amputated patients experienced PLP. Phantom limb pain therapy is challenging because its mechanism is not precise yet. In recent years, many therapies are being studied; they are divided into pharmacologic and nonpharmacologic therapy. Pharmacologic treatment such as BoNT/A injection, antidepressants (amitriptyline), anticonvulsants (pregabalin and gabapentin), opioids, NMDA receptor antagonists (memantine and ketamine), and capsaicin 8% patch. Nonpharmacologic therapy such as mirror therapy, transcutaneous electrical stimulation (TENS), spinal cauda equina stimulation, cryoneurolysis, and acupuncture. However, from all those studies, they conclude that there is no first-line treatment. In this review, modalities for PLP treatment over the past few years will be discussed.