Suggested guidelines for treatment of phantom limb pain

Eighty to ninety percent of amputees have been shown to suffer significant amounts of phantom limb pain in contrast to the widely accepted level of about 5%. Surveys of the literature, of physicians actively treating phantom pain, and of over 3,000 American veteran amputees have shown that most of the usual treatments are not efficacious when followups of a year or more are done. A diagnostic and therapeutic schemata is presented, which incorporates the above surveys, research, and clinical experience into a unified approach optimizing the few treatments showing a reasonable hope of long term success. Every effort is made to identify the source of pain being referred into the phantom. Stump, back, prosthetic, and other physical problems are corrected prior to initiation of other treatments, including EMG or temperature feedback from the stump, sympathetic system alteration, modulation of anxiety and depression, TENS, and ultrasound. Key indexing terms: phantom pain, treatment, amputees, referred pain.