Phantom limb pain: actual concepts of pathophysiology and treatment methods from the standpoint of evidence-based medicine

Abstract

Rationale. Despite a large number of studies on the effectiveness of various pharmacological and non- pharmacological therapies, PLP treatment tactics have not yet been developed, which is largely due to the complex mechanism of the formation of this pathology. Although PLP is classified as neuropathic pain, standard methods of neuropathic pain therapy are not always effective for this syndrome. To optimize the regimens of existing methods of PLP treatment, as well as the search and clinical trials of new therapeutic approaches, it is necessary to take into account the currently available evidence base.Material and methods. Our analysis included publications on phantom pain treatment methods with a high level of evidence (randomized controlled trials, systematic reviews and meta-analyses). Literature search was performed in Medline PubMed and eLIBRARY systems.Results. The review provides an evidence base for pharmacotherapy methods (opioids, NMDA-receptor antagonists, tricyclic antidepressants, anticonvulsants, local anesthetics), for methods based on the phantom illusion (mirror therapy, motion representation, virtual reality), for non-invasive (transcutaneous electrical neurostimulation, transcranial magnetic stimulation, transcranial electrical stimulation) and invasive (deep brain stimulation, motor cortex stimulation, spinal cord stimulation, dorsal root ganglion stimulation) neuromodulation. Data on the most studied dosing regimens of different methods of pharmacological and non-pharmacological therapy are presented.