Spinal Cord Stimulation Therapy for Phantom Limb Pain in the Left Lower Extremity 30 Years After Onset

A male patient in his 70s underwent left hip disarticulation 34 years ago due to a malignant tumor in the left thigh. Phantom limb pain developed 30 years ago, with night pain worsening nine years ago. Despite increasing the codeine phosphate dosage and performing a caudal epidural block, his pain did not improve, leading him to visit our hospital. He experienced sharp, electric-like pain in the phantom left sole, with a Visual Analogue Scale score of 100 mm. The phantom limb sensation was in a flexed lower-limb position, and he was unable to move it voluntarily. Temporary pain relief was achieved through a lumbar epidural block. Rehabilitation was initiated, including mirror therapy and exercise therapy for areas outside the affected limb. Six months later, somatosensory sensation returned in the phantom limb, and pulsed radiofrequency was applied to the left L5 and S1 nerve roots, resulting in pain relief. However, pain recurred 10 months later. The patient continued exercise therapy, and after 12 months, voluntary movement of the phantom limb was achieved. Spinal cord stimulation (SCS) therapy was then performed. After the trial, phantom pain decreased, and insomnia caused by night pain improved, leading to implantation. In this case, effective treatment was achieved using SCS for phantom limb pain that had persisted for 30 years. Although there were concerns regarding the chronic nature of the phantom pain and the difficulty of achieving treatment success, rehabilitation combined with SCS appeared to enhance the treatment outcome.