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Pharmacologic interventions for treating phantom limb pain.

The Cochrane database of systematic reviews·2011
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Author Spotlight: Insights into Remotely Supervised Neuromodulation Procedure for Phantom Limb Pain
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Pharmacologic interventions for treating phantom limb pain.

Maria Jenelyn M Alviar1, Tom Hale, Monalisa Dungca

  • 1University of Melbourne-Royal Melbourne Hospital, Grattan St, Melbourne, Victoria, Australia, 3010.

The Cochrane Database of Systematic Reviews
|October 14, 2016
PubMed
Summary

Pharmacologic management for phantom limb pain (PLP) remains uncertain. While morphine, gabapentin, and ketamine show short-term benefits, evidence for other drugs is inconclusive, necessitating further research.

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Area of Science:

  • Pharmacology
  • Neurology
  • Pain Management

Background:

  • Phantom limb pain (PLP) is severe, disabling pain following amputation.
  • Optimal pharmacologic management for PLP is currently uncertain.
  • This review updates evidence on drug effectiveness for PLP.

Purpose of the Study:

  • To summarize evidence on the effectiveness of pharmacologic interventions for treating PLP.
  • To evaluate various drug classes, including botulinum neurotoxins, opioids, and NMDA receptor antagonists.

Main Methods:

  • Searched Cochrane CENTRAL, MEDLINE, and Embase up to April 2016.
  • Included 14 randomized and quasi-randomized trials with 269 participants.
  • Assessed pain intensity, function, mood, sleep, quality of life, and adverse events.

Main Results:

  • Botulinum toxin A (BoNT/A) did not improve PLP compared to lidocaine/methylprednisolone.
  • Morphine, gabapentin, and ketamine showed short-term pain relief compared to placebo.
  • Adverse events were reported for most effective treatments; many studies had small sample sizes.

Conclusions:

  • Short-term efficacy of morphine, gabapentin, and ketamine for PLP is supported.
  • Effectiveness of BoNT/A, memantine, and amitriptyline for PLP is unclear or not supported.
  • Larger, rigorous trials are needed to establish definitive pharmacologic treatments for PLP.