Current and future options for the management of phantom-limb pain

Abstract

Phantom-limb pain (PLP) belongs among difficult-to-treat chronic pain syndromes. Treatment options for PLP are to a large degree implicated by the level of understanding the mechanisms and nature of PLP. Research and clinical findings acknowledge the neuropathic nature of PLP and also suggest that both peripheral as well as central mechanisms, including neuroplastic changes in central nervous system, can contribute to PLP. Neuroimaging studies in PLP have indicated a relation between PLP and the neuroplastic changes. Further, it has been shown that the pathological neuroplastic changes could be reverted, and there is a parallel between an improvement (reversal) of the neuroplastic changes in PLP and pain relief. These findings facilitated explorations of novel neuromodulatory treatment strategies, adding to the variety of treatment approaches in PLP. Overall, available treatment options in PLP include pharmacological treatment, supportive non-pharmacological non-invasive strategies (eg, neuromodulation using transcranial magnetic stimulation, visual feedback therapy, or motor imagery; peripheral transcutaneous electrical nerve stimulation, physical therapy, reflexology, or various psychotherapeutic approaches), and invasive treatment strategies (eg, surgical destructive procedures, nerve blocks, or invasive neuromodulation using deep brain stimulation, motor cortex stimulation, or spinal cord stimulation). Venues of further development in PLP management include a technological and methodological improvement of existing treatment methods, an implementation of new techniques and products, and a development of new treatment approaches.

Repetitive Transcranial Magnetic Stimulation for Phantom Limb Pain in Land Mine Victims: A Double-Blinded, Randomized, Sham-Controlled Trial

“…1,16,39 Additionally, psychological factors may affect pain duration and severity. 23 The high prevalence of PLP after amputation and its lack of treatment response have resulted in major efforts to look for interventions to decrease the pain in those affected patients. 11 Given PLP mechanisms, repetitive transcranial magnetic stimulation (rTMS) has been tested in this condition as a tool to block the maladaptive plasticity in the sensorimotor cortex.…”

Etiology of phantom limb syndrome: Insights from a 3D default space consciousness model

“…The study also found that pain reduction was associated with decreased activity in the inferior parietal cortex [10]. The success of mirror therapy suggests that visual feedback can outcompete other sensory systems and can actually elicit sensory experiences from other sensory systems [24]. A study using mental imagery training in order to imagine moving and relaxing the phantom limb also found a significant reduction in PLP [27], along with elimination of cortical reorganization.…”

Neuropathic Pain: Literature Review and Recommendations of Potential Phytotherapies

“…In phantom pain, spinal cord thermolesion and stimulations of the peripheral nerves are effective, while neurodestruction is possible in stump pain. [32][33][34] Post-traumatic Pain (PTP) and Post-operative Pain (PPP) PPP and PTP are chronic pathological pains which are associated with surgery or trauma and are present for more than normal tissue healing time, and their intensities, characters and localizations would not be explicated by the incident of other pathologies, for instance, disease recurrence, cancer or infection recurrence. 35 Prophylactic measures prior to surgeries are recommended to reduce the risk of nerve damage; for instance, techniques for epidural anesthesia; using local anesthetics for surgical wounds; pregabalin or gabapentin use in perioperative phase Despite the lack of evidence, it's recommended to give lidocaine intravenous infusions in all risk groups (young patients, long duration surgeries, poor treatment of severe post-operative pain).…”