[Therapy of phantom limb pain]

Area of Science:

• Neuroscience
• Pain Medicine
• Rehabilitation

Context:

• Phantom limb pain (PLP) is a common and debilitating complication following extremity amputation, affecting approximately 80% of patients.
• Distinguishing between painful phantom limb sensations, non-painful sensations, and residual limb pain is crucial for effective management.
• The underlying pathophysiology of PLP is complex and not fully elucidated, though current research highlights the significance of central nervous system changes.

Purpose:

• To review the current understanding of phantom limb pain pathophysiology.
• To outline established and emerging therapeutic strategies for managing phantom limb pain.
• To discuss perioperative considerations for amputation surgery to mitigate PLP.

Summary:

• Cortical reorganization and altered body perception are identified as major contributors to phantom limb pain pathophysiology.
• Pharmacological interventions, including antidepressants, anticonvulsants, and opioids, are essential components of PLP management.
• Senso-motory training, encompassing mirror therapy, lateralization, and motor imagery, offers significant therapeutic benefits.

Impact:

• Improved understanding of PLP pathophysiology can guide the development of more targeted and effective treatments.
• Integration of pharmacological and senso-motory therapies can enhance patient outcomes and quality of life post-amputation.
• Consideration of perioperative pain management strategies, such as epidural or axillary plexus catheters, may reduce the incidence and severity of PLP.