A scoping review of spinal cord stimulation for phantom limb pain

Background

Phantom limb pain (PLP) is a debilitating condition that affects individuals following limb amputation. While medical management with anticonvulsants and physical therapy is the first-line treatment, spinal cord stimulation (SCS) has emerged as an option for patients with persistent, refractory pain.

Objectives

This study aimed to evaluate the current literature on SCS for PLP, focusing on pain reduction and associated complications.

Methods

A systematic review was conducted on reports of adults (≥18 years) with phantom limb pain treated with spinal cord stimulation. Titles and abstracts were screened, followed by a full-text review based on predefined inclusion criteria. Extracted data included sample size, SCS lead placement, pain reduction, visual analog scale (VAS) and brief pain inventory (BPI) scores, and complications. Descriptive statistics were used for analysis.

Results

Five reports met inclusion criteria, comprising 33 patients. Of these, 18 % of patients achieved 90–100 % pain reduction, 15 % had ≥80 % reduction, 6 % had ≥60 % reduction, and 15 % experienced ≥50 % reduction. Post-SCS visual analog scores were reported in two studies; one study reported a mean 50 % reduction in visual analog scale scores (VAS), while another found a median brief pain inventory (BPI) reduction of 43.5 %. Complications across all 33 patients included wound infection (6 %), transient weakness (3 %), cerebrospinal fluid leak (3 %), allergic dermatitis (3 %), and electrode site cyst (3 %). Most patients (84.8 %) received epidural lead placement, while 15.2 % had subdural placement.

Conclusions

SCS may be effective in reducing pain in some PLP patients.However complications exist, with wound infection being the most common complication. The mechanism of action remains unclear, but PLP likely involves both central and peripheral pathology, which complicates treatment. Historically, SCS has shifted from subdural to epidural lead placement to minimize complications, with recent reports exploring dorsal root ganglion stimulation for more targeted pain relief. Spinal cord stimulation appears to provide meaningful pain reduction for patients with phantom limb pain, with a subset achieving near-complete relief. However, reported outcomes vary and complications remain a concern. Given the limited number of reports and small sample sizes, further research is needed to assess long-term efficacy and to minimize complications.