[Pain Therapy for Phantom Pain].

Abstract

Phantom pain (PP) is a neuropathic pain syndrome that occurs after limb amputation and is perceived in the absent body part. Its exact pathophysiology remains unclear but involves peripheral nerve lesions, central sensitization, and cortical reorganization. Psychological and social factors also play a significant role in its manifestation. Phantom pain after amputation shows wide variability, affecting up to 82% of patients within the first postoperative year, with lifetime prevalence exceeding 80%, and higher rates observed after proximal or major amputations (e.g., transfemoral). Symptoms are typically described as intermittent, burning, or electric-like pain, often accompanied by non-painful phantom sensations. Diagnosis requires thorough neurological evaluation, detailed pain documentation, and the exclusion of differential diagnoses. Preventive strategies include perioperative nerve blocks and adequate surgical soft tissue coverage. Effective treatment is based on a multimodal approach. Pharmacological options such as morphine and pregabalin have shown efficacy, while others like tramadol or gabapentin appear less effective. Non-pharmacological methods - including mirror therapy and transcutaneous electrical nerve stimulation (TENS) - can support pain relief. Psychological interventions, particularly trauma-focused therapy, may be beneficial, especially in patients with post-traumatic stress symptoms. For optimal management, an individualized treatment plan combining pharmacological, physical, and psychological strategies is recommended.