Authors
Kondratyev I.A., Dzhodzhua A.V., Anankin A.A., Semenov A.H., Gavrilchenko V.S.
Pirogov National Medical and Surgical Center, Moscow
Abstract
The number of limb amputations is increasing every year in the world. The reason for this may be a limb injury, infection, acute ischemia, a complication of diabetes mellitus, or a malignant tumor. On average, in more than half of cases, patients develop phantom sensations, which can be painless and painful. The feeling of touch, itching, and pressure can be painless. Painful sensations are electric shock, burning, stabbing or throbbing pain. Some patients describe phantom pain as an «electric shock», others as a «burning sensation», and others as «insects crawling inside».
Phantom pain was described in the 16th century by Ambroise Pare and since then this term has been constantly present in the medical literature. Unfortunately, for such a long time, the exact pathogenesis of the disease has not been established and methods for the prevention and treatment of phantom pain have not been developed. This review describes the current view of the mechanism of phantom pain syndrome, and also examines the main therapy used in the treatment of phantom pain at the present stage, both before and after amputation.
Keywords: phantom pain, phantom limb pain, amputation.
References
1. AlMehman DA, Faden AS, Aldahlawi BM, Bafail MS, Alkhatieb MT, Kaki AM. Post-amputation pain among lower limb amputees in a tertiary care hospital in Jeddah, Saudi Arabia. Saudi Med J. February. 2022; 43(2): 187-96.
2. Burger H, Marinc’ek C. The life style of young persons after lower limb amputation caused by injury. Prosthet Orthot Int. 1997; 21(1): 35.
3. Subedi B, Grossberg GT. Phantom Limb Pain: Mechanisms and Treatment Approaches. Pain Res Treat. 2011: 864605.
4. Konstantinovich ChO, Vladimirovich KS, Sergeyevna KE, Anatolyevich SA. Phantom Pain Syndrome: Pathogenesis, Treatment, Prevention (Literature Review). Genius of Orthopedics. 2014; 1: 89-93. (In Russ.)
5. Hanyu-Deutmeyer AA, Cascella M, Varacallo MA. Phantom Limb Pain. В: StatPearls [Интернет]. Treasure Island (FL): StatPearls Publishing; 2025 .
6. Lange JWD de, Hundepool CA, Power DM, Rajaratnam V, Duraku LS, Zuidam JM. Prevention is better than cure: Surgical methods for neuropathic pain prevention following amputation – A systematic review. J Plast Reconstr Aesthet Surg. March 1, 2022; 75(3): 948-59.
7. Schone HR, Baker CI, Katz J, Nikolajsen L, Limakatso K, Flor H, и др. Making sense of phantom limb pain. J Neurol Neurosurg Psychiatry. 2022; 93(8): 833-43.
8. Nortvedt F, Engelsrud G. “Imprisoned” in pain: analyzing personal experiences of phantom pain. Med Health Care Philos. 2014; 17(4): 599-608.
9. Limakatso K, Bedwell GJ, Madden VJ, Parker R. The prevalence and risk factors for phantom limb pain in people with amputations: A systematic review and meta-analysis. PLoS ONE. 2020; 15(10): e0240431.
10. Yin Y, Zhang L, Xiao H, Wen CB, Dai YE, Yang G, et al. The pre-amputation pain and the postoperative deafferentation are the risk factors of phantom limb pain: a clinical survey in a sample of Chinese population. BMC Anesthesiol. 2017; 17: 69.
11. Fuchs X, Flor H, Bekrater-Bodmann R. Psychological Factors Associated with Phantom Limb Pain: A Review of Recent Findings. Pain Res Manag. 2018; 2018: 5080123.
12. Kuffler DP. Evolving techniques for reducing phantom limb pain. Exp Biol Med. 2023; 248(7): 561-72.
13. Nieto-Salazar MA. Phantom Limb Pain: Current Concepts and Treatment Strategies. Open Access J Neurol Neurosurg. 18(2): 01-8.
14. Yusupova DG, Suponeva NA, Zimin AA, Zaytsev AB, et al.Validation of the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS) in Russia. Neuromuscular Diseases. 2018; 8(3): 43-50. (In Russ.) doi: 10.17650/2222-8721-2018-8-3-43-50.
15. Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. PAIN. 2001; 92(1): 147.
16. Vizual’no-analogovaya shkala dlya boli v anesteziologii i reanimatologii. [internet] Anesteziologiya i reanimatologiya. Available at: https://anest-rean.ru/international-scale/visual-analog-scale-vas-for-pain/. (In Russ.)
17. Shmueli A. The visual analog rating scale of health-related quality of life: an examination of end-digit preferences. Health Qual Life Outcomes. 2005; 3(1): 71.
18. Davyidov OS, Yakhno NN, Kukushkin ML, et al. Neuropathic Pain: Clinical Guidelines for Diagnosis and Treatment of the Russian Pain Society. Neurology. 2019; 458. (In Russ.) doi: 10.25731/RASP.2018.04.025.
19. Alekseyeva NM, et al. Visual feedback – mirror therapy in neurorehabilitation. Annals of Clinical and Experimental Neurology. 2012; 6(4): 36-41. (In Russ.)
20. Federal Clinical Guidelines for Preventing Phantom Pain Syndrome After Limb Amputation. Federation of Anesthesiologists and Resuscitators of the Russian Federation. 2014. (In Russ.)
21. Alviar MJM, Hale T, Lim-Dungca M. Pharmacologic interventions for treating phantom limb pain – Alviar. MJM. 2016. Cochrane Library.
22. Modest JM, Raducha JE, Testa EJ, Eberson CP. Management of Post-Amputation Pain. R I Med J. 2013. 2020; 103(4): 19-22.
23. Erlenwein J, Diers M, Ernst J, Schulz F, Petzke F. Clinical updates on phantom limb pain. Pain Rep. 2021; 6(1): e888.
24. Ian G, Sarah JLF. Gabapentin and Pregabalin for the Treatment of Neuropathic Pain: A Review of Laboratory and Clinical Evidence. Gilron. 2006. Pain Research and Management. Wiley Online Library.
25. Rogers AG. Use of amitriptyline (Elavil) for phantom limb pain in younger children. J Pain Symptom Manage. 1989; 4(2): 96.
26. Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Moore. RA. 2015. Cochrane Library.
27. Makkar JK, Bandyopadhay A, Jain K, Jafra A, Gopinathan NR, Singh P. Effect of perioperative sciatic nerve block on chronic pain in patients undergoing below-knee amputation: A randomised controlled trial. Indian J Anaesth. 2022; 66(S6): S300-6.
28. Valerio Е, Lautenslager L, Vonu Р, Chopan M. Efficacy of targeted muscle reinnervation for treating and preventing postamputation pain – a systematic review. October 22, 2024.
29. Fulton ZW, Boothby BC, Phillips SA. Targeted Muscle Reinnervation for Trauma-Related Amputees: A Systematic Review. Cureus. 14(8): e28474.
30. Vadalà G, Di Pino G, Ambrosio L, Diaz Balzani L, Denaro V. Targeted muscle reinnervation for improved control of myoelectric upper limb prostheses. J Biol Regul Homeost Agents. 2017; 31(4s1): 183-9.
31. Johnson MI, Mulvey MR, Bagnall AM. Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults. Cochrane Database Syst Rev. 2015; 8: CD007264.
32. Kannan P, Bello UM, Winser SJ. Physiotherapy interventions may relieve pain in individuals with central neuropathic pain: a systematic review and meta-analysis of randomised controlled trials. Ther Adv Chronic Dis. 2022; 13: 20406223221078672.