Phantom Limb (Phantom Limbs)

Perception of painful and nonpainful phantom sensations that occur following the complete or partial loss of a limb. The majority of individuals with an amputated extremity will experience the impression that the limb is still present, and in many cases, painful. (From Neurol Clin 1998 Nov;16(4):919-36; Brain 1998 Sep;121(Pt 9):1603-30)

Also Known As:

Networked: 1212 relevant articles (102 outcomes, 172 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Pain (Aches)
2.	Phantom Limb (Phantom Limbs)
3.	Complex Regional Pain Syndromes
4.	Stroke (Strokes)
5.	Neuralgia (Stump Neuralgia)

Experts

1.	Flor, Herta: 18 articles (05/2022 - 07/2002)
2.	Tsao, Jack W: 15 articles (01/2019 - 11/2007)
3.	Flor, H: 13 articles (01/2017 - 10/2000)
4.	Fregni, Felipe: 11 articles (08/2021 - 08/2013)
5.	Weiss, Thomas: 11 articles (01/2018 - 11/2011)
6.	Bekrater-Bodmann, Robin: 10 articles (01/2022 - 12/2011)
7.	Nikolajsen, Lone: 9 articles (05/2022 - 11/2006)
8.	Dijkstra, Pieter U: 9 articles (01/2022 - 07/2000)
9.	Dietrich, Caroline: 9 articles (01/2018 - 11/2011)
10.	Hofmann, Gunther O: 9 articles (01/2018 - 11/2011)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Phantom Limb:

1.	Calcitonin (Calcitonin, Eel)FDA LinkGeneric 04/01/2008 - "Calcitonin was effective in a study of acute phantom limb pain, but it was not studied in the chronic phase. " 06/01/2023 - "Additionally, Google Scholar was searched manually with the search term "calcitonin phantom limb pain". " 06/01/2023 - "Calcitonin in the Treatment of Phantom Limb Pain: A Systematic Review." 12/15/2012 - "The use of calcitonin to relieve severe, treatment-refractory phantom limb pain (PLP) is reported. " 12/15/2012 - "Calcitonin for phantom limb pain in a pregnant woman."
2.	Gabapentin (Neurontin)FDA LinkGeneric 12/01/2012 - "Efficacy of gabapentin for treatment of adults with phantom limb pain." 12/01/2012 - "A strong recommendation for the effectiveness of gabapentin in phantom limb pain cannot be ascertained until more methodologically sound studies are executed in this population." 12/01/2012 - "Given the results of these trials, oral gabapentin in patients aged 18 years or older may decrease phantom limb pain. " 12/01/2012 - "Randomized controlled trials that studied the effectiveness of gabapentin in adults with phantom limb pain were identified and selected. " 12/01/2012 - "A PubMed search (1966-September 2012) was conducted using the key words phantom limb pain and gabapentin. "
3.	Morphine (MS Contin)FDA LinkGeneric 10/01/2023 - "Further work should investigate the association between perioperative morphine requirements and late phantom limb pain. " 10/01/2023 - "High postoperative morphine consumption was associated with worsening phantom limb pain both at rest (-17.51, 95% CI -24.29 to -10.74; p<0.001) and on movement (-18.54, 95% CI -25.58 to -11.49; p<0.001). " 01/01/2015 - "Long-Term High-dose Oral Morphine in Phantom Limb Pain with No Addiction Risk." 01/01/2007 - "High-dose morphine for intractable phantom limb pain." 04/01/2002 - "Compared with placebo, morphine reduced both stump and phantom pains significantly (P < 0.01). "
4.	Bupivacaine (Bupivacaine Hydrochloride)FDA LinkGeneric 05/01/2009 - "Bupivacaine consistently reduced/abolished the phantom sensation in 6 out of 8 patients. " 05/01/2009 - "Contralateral injections of 1 ml 0.25% bupivacaine in myofascial hyperalgesic areas attenuated phantom limb pain and affected phantom limb sensation. " 06/01/1988 - "The aim of this study was to investigate if it was possible to reduce postoperative phantom limb pain by giving lumbar epidural blockade (LEB) with bupivacaine and morphine for 72 h prior to the operation. " 03/01/2005 - "Intrathecal morphine and bupivacaine for phantom limb pain: a case report." 07/01/1998 - "Long-Term Intrathecal Infusion of Opioid and/or Bupivacaine in the Prophylaxis and Treatment of Phantom Limb Pain."
5.	Clonidine (ST 155)FDA LinkGeneric 05/01/2007 - "We report the efficacy of perioperative infusion of clonidine and bupivacaine for above-knee amputation in a patient with a history of phantom limb pain in the same extremity after a previous below-knee amputation. " 05/01/2007 - "The efficacy of postoperative perineural infusion of bupivacaine and clonidine after lower extremity amputation in preventing phantom limb and stump pain." 01/01/1993 - "[Temporary relief from pain in the phantom limb after spinal anesthesia using a combination of bupivacaine and clonidine]." 11/01/2010 - "The beneficial effect of combined bupivacaine, diamorphine, and clonidine in reducing the risk of phantom limb pain was supported by only one study (level 3 evidence). " 09/01/1994 - "We conclude that perioperative epidural infusion of diamorphine, clonidine and bupivacaine is safe and effective in reducing the incidence of phantom pain after amputation."
6.	Analgesics (Analgesic Drugs)IBA 08/01/2017 - "The analgesic effect of neurorehabilitative visual feedback during phantom limb movement is significantly improved by applying somatosensory feedback to the cheek on the affected side. " 01/01/2021 - "Current analgesic treatments for phantom pain are not optimal. " 01/01/2019 - "The patient with evidence of cortical reorganization and almost 60 years of debilitating phantom limb pain experienced sustained analgesic relief at a follow-up period of 6 months. " 01/01/2017 - "VR rehabilitation may encourage patient's motivation and multimodal sensorimotor re-integration of a phantom limb and subsequently have a potent analgesic effect. " 02/01/2008 - "This was a retrospective review and clinical notes of these patients were analysed to assess their post operative course, analgesic requirements and to ascertain phantom limb pain/sensation rates. "
7.	Opioid Analgesics (Opioids)IBA 07/01/2001 - "Study endpoints were rate of stump and phantom pain, intensity of stump and phantom pain, and consumption of opioids. " 11/08/1997 - "Study endpoints were rate of stump and phantom pain, intensity of stump and phantom pain, and consumption of opioids. " 07/01/2013 - "Current treatment to relieve phantom limb pain consists of physical, behavioral, and medical modalities including opioids and adjunct medications. " 06/01/2010 - "Is preoperative opioid utilization an important factor in predicting phantom limb pain?" 02/01/2001 - "Thus, opioids show efficacy in the treatment of phantom limb pain and may potentially influence also cortical reorganization. "
8.	KetamineFDA LinkGeneric 03/01/2010 - "Treatment with intravenous (IV) ketamine as an alternate day infusion, gave complete remission of phantom limb pain. " 01/01/2018 - "Future studies will determine if the perioperative oral ketamine also reduces the incidence of chronic stump or phantom limb pain." 09/01/1996 - "Ketamine (bolus at 0.1 mg/kg/5 min followed by an infusion of 7 micrograms/kg/min) was administered intravenously to 11 patients with established stump and phantom limb pain in a double-blind saline-controlled study. " 07/01/2015 - "Oral ketamine for phantom limb pain: An option for challenging cases." 08/01/2014 - "Phantom limb pain exacerbated by intravenous ketamine."
9.	N-Methyl-D-Aspartate Receptors (NMDA Receptors)IBA 09/01/1996 - "NMDA receptor antagonists may have a potential in the treatment of stump and phantom limb pain." 06/01/2002 - "Continuous brachial plexus analgesia and NMDA-receptor blockade in early phantom limb pain: a report of two cases." 04/01/2003 - "Persistent phantom pain probably involves NMDA receptor hyperexcitability because DM 120 to 270 mg/day mitigated the pain satisfactorily." 09/01/1996 - "The results support the notion that stump and phantom pain are generated by activity in afferent fibres activated by mechanical but not by thermal stimuli and that the NMDA receptor is involved in the maintenance of postamputation pain states. " 06/01/2002 - "The combination of long-term regional analgesia with prolonged block of NMDA receptors might be effective for treatment and prevention of phantom limb pain following traumatic amputations. "
10.	Capsaicin (Zostrix)FDA Link 01/01/2017 - "Capsaicin 8% patch treatment for amputation stump and phantom limb pain: a clinical and functional MRI study." 08/01/2014 - "[Capsaicin 8 % cutaneous patches for phantom limb pain. " 01/01/2017 - "The aim of this study was to measure the efficacy of a single 60 min application of capsaicin 8% patch in reducing chronic amputation stump and phantom limb pain, associated hypersensitivity with quantitative sensory testing, and changes in brain cortical maps using functional MRI (fMRI) scans. " 01/01/2017 - "Phantom limb pain ("central" pain) and associated brain plasticity may be modulated by peripheral inputs, as they can be ameliorated by the peripherally restricted effect of the capsaicin 8% patch." 08/01/2014 - "Capsaicin 8 % cutaneous patches seem to be effective and safe for the treatment of post amputation pain, notably in patients suffering from phantom limb pain."

Therapies and Procedures

1.	Surgical Amputation (Amputations) 01/01/2003 - "Pre-, intra- and postoperative EDA was associated with a significant reduction of phantom limb pain 12 months after amputation, NNT = 5,8 (95%-CI 3,2-28,6). " 01/01/2021 - "Discussion: MI is a time- and cost-effective, low-risk treatment option that decreased phantom pain and improved balance and functional gait in an individual with an amputation. " 12/01/2020 - "To investigate whether graded motor imagery (GMI) is effective for reducing phantom limb pain (PLP) in people who have undergone limb amputations. " 09/01/2017 - "The aim of this study was to evaluate the efficacy of eye movement desensitization and reprocessing (EMDR) on the phantom limb pain (PLP) of patients with amputations within a 24-month follow-up. " 09/06/2021 - "Reduction of Phantom Limb Pain and Improved Proprioception through a TSR-Based Surgical Technique: A Case Series of Four Patients with Lower Limb Amputation."
2.	Mirror Movement Therapy 05/20/2023 - "Mirror therapy has been proven to be effective in treating phantom limb pain and other conditions such as CRPS. " 10/01/2013 - "In the current study we therefore implemented an alternative version of the mirror therapy involving a visuotactile illusion, to explore whether it might be effective with amputees for whom the action of moving the phantom increases phantom pain. " 12/01/2022 - "Current literature claims that mirror therapy is effective in reducing phantom limb pain in post amputees, but there are only a few case reports emphasizing mirror therapy in particularly lower limb amputees. " 07/01/2009 - "Performing phantom movements with visual virtual feedback, or mirror therapy, is a promising treatment avenue to alleviate phantom limb pain. " 01/01/2023 - "Case report: A combination of mirror therapy and magnetic stimulation to the sacral plexus relieved phantom limb pain in a patient."
3.	Prostheses and Implants (Prosthesis) 01/01/2018 - "There was also a statistically significant reduction in reported phantom pain after experimental sessions that included open-loop nerve microstimulation, open-loop prosthesis motor control, or closed-loop prosthesis motor control. " 01/01/2020 - "Participants expressed enhanced prosthetic function, increased and more diverse prosthesis use in tasks of daily living, and improved relationships between their prosthesis and phantom limb. " 01/01/2015 - "Myoelectric prostheses have been shown to improve cosmesis and phantom-limb pain and are more accepted for light=intensity work. " 01/01/2022 - "The addition of sensory feedback to upper-limb prostheses has been shown to improve control, increase embodiment, and reduce phantom limb pain. " 01/01/2020 - "The incorporation of sensory feedback in prosthetics can lead to a range of benefits, such as improved hand control, increased prosthesis embodiment, and the reduction of phantom limb pain. "
4.	Analgesia 11/01/1998 - "Thus, the patient not only received analgesia, but also got an effective treatment of established phantom pain. " 03/01/1994 - "Pre-emptive analgesia is advantageous in out-patient surgery as well as for routine clinical anaesthesia, and has proved effective in the prevention of phantom limb pain. " 01/01/2023 - "In this report, we describe three amputee patients with severe phantom limb pain who obtained substantial analgesia and improvement in physical functionality after implantation of a temporary PNS device. " 03/01/2001 - "Salient clinical examples of these effects include amputees with pains in a phantom limb that are similar or identical to those felt in the limb before it was amputated, and patients after surgery who have benefited from preemptive analgesia which blocks the surgery-induced afferent barrage and/or its central consequences. " 01/01/2001 - "The efficacy of pre-emptive analgesia for phantom limb pain is still unclear. "
5.	Therapeutics 07/06/2016 - "Despite the multiple available pharmacological and behavioral therapies for the management of chronic phantom limb pain (PLP) in lower limb amputees, treatment for this condition is still a major challenge and the results are mixed. " 11/01/2018 - "We reviewed all literature looking at the evidence for the efficacy of both single and combined pharmacological therapy in the management of phantom limb pain. " 11/01/2011 - "Mirror visual feedback therapy has been shown to improve phantom pain. " 01/01/2022 - "Central nervous system stimulation therapies in phantom limb pain: a systematic review of clinical trials." 09/01/2001 - "Data from fMRI can be used to evaluate phantom limb virtual movements and to study cortical reorganization phenomena that can appear with time or as a result of some therapies. "