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Treatment Strategies and Effective Management of Phantom Limb–Associated Pain

  • Ivan UritsEmail author
  • Danica Seifert
  • Allison Seats
  • Stephen Giacomazzi
  • Michael Kipp
  • Vwaire Orhurhu
  • Alan D. Kaye
  • Omar Viswanath
Hot Topics in Pain and Headache (N Rosen, Section Editor)
  • 101 Downloads
Part of the following topical collections:
  1. Topical Collection on Hot Topics in Pain and Headache

Abstract

Purpose of Review

Phantom sensations are incompletely understood phenomena which take place following an amputation or deafferentation of a limb. They can present as kinetic, kinesthetic, or exteroceptive perceptions. It is estimated that phantom limb pain (PLP) affects anywhere from 40 to 80% of amputees.

Recent Findings

Psychiatric illnesses such as depression, anxiety, and mood disorders have higher prevalence in amputees than in the general population. Pharmacologic treatment has been used as first-line therapy for amputees suffering from PLP with agents including gabapentinoids, amitriptyline, and other tricyclic anti-depressants, opioids, and local anesthetics. Non-invasive treatment modalities exist for PLP including sensory motor training, mirror visual therapy, and non-invasive neuromodulation. Non-invasive neuromodulation includes interventions like transcutaneous electrical nerve stimulation (TENS) and transcranial magnetic stimulation.

Summary

While many promising therapies for PLP exist, more clinical trials are required to determine the efficacy and protocols needed for maximum benefit in patients suffering from PLP.

Keywords

Phantom limb Phantom limb pain PLP Amputation Pain management 

Notes

Compliance with Ethical Standards

Conflict of Interest

Ivan Urits, Danica Seifert, Allison Seats, Stephen Giacomazzi, Michael Kipp, Vwaire Orhurhu, and Omar Viswanath declare no conflict of interest. Alan D. Kaye discloses that he is on the Speakers Bureau for Depomed, Inc. and Merck.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ivan Urits
    • 1
    Email author
  • Danica Seifert
    • 2
  • Allison Seats
    • 2
  • Stephen Giacomazzi
    • 2
  • Michael Kipp
    • 3
    • 4
  • Vwaire Orhurhu
    • 1
  • Alan D. Kaye
    • 5
  • Omar Viswanath
    • 3
    • 6
    • 7
  1. 1.Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain MedicineHarvard Medical SchoolBostonUSA
  2. 2.Creighton University School of MedicinePhoenixUSA
  3. 3.Valley Anesthesiology and Pain ConsultantsPhoenixUSA
  4. 4.Midwestern UniversityGlendaleUSA
  5. 5.Department of AnesthesiologyLouisiana State University Health Sciences CenterNew OrleansUSA
  6. 6.Department of AnesthesiologyUniversity of Arizona College of Medicine-PhoenixPhoenixUSA
  7. 7.Department of AnesthesiologyCreighton University School of MedicineOmahaUSA

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