Phantom Limb Pain

Abstract

First described in the 16th century, phantom limb pain (PLP) describes the painful sensations resulting from a lost body part, classically a lost limb. This article reviews the incidence, clinical course, pathophysiology, and current treatment options for PLP. The reported incidence of PLP varies widely from 0.5 to 90% because of sampling biases and the lack of differentiating PLP from stump pain or phantom sensations. The clinical course is rapid with symptoms typically occurring within the first week of limb loss and persisting for up to 2 years or more. Although both psychiatric and peripheral causes have been proposed, recent studies suggest a primary role of the central nervous system in the genesis of PLP. Treatment of PLP remains difficult, with no single modality sufficient to manage the pain. Optimal management currently involves a multidisciplinary approach involving physical treatments, pharmacologic intervention, and psychiatric therapy. Surgical options remain limited although novel interventions such as motor cortex stimulation may be beneficial.