Preventive Approach to Phantom Limb Pain in Lower Limb Ablation Surgery: A Systematic Review.

Purpose: The purpose of this systematic review is to explore strategies for preventing phantom limb pain in amputated patients. Given the complex mechanisms of peripheral and central sensitization underlying phantom limb pain and the limited effectiveness of current pharmacological and non-pharmacological treatments, prevention is critical to reducing its impact on patients' quality of life and treatment burden.

Methods: Through a comprehensive search from four databases about the prevention of phantom limb pain, 1781 articles published between 2014 and 2024 were identified. Human studies that measured the association between preventive methods for phantom limb pain were considered eligible. The inclusion criteria of the literature were (1) prevention/ prophylactic treatment of phantom limb pain among amputees, (2) publication within the last 10 years, (3) randomized controlled trial or cohort, and (4) study written in English. Animal studies were excluded from this analysis.

Results: Four randomized controlled trials and one cohort were included in this study. To prevent phantom limb pain, various approaches can be taken, both operative and non-operative. Surgery involving a combination of peripheral nerve coaptation, collagen nerve wrapping, and submuscular transposition, when compared to neurectomy alone, has demonstrated satisfactory results. In the non-surgical method, the administration of dexmedetomidine and calcitonin as an epidural injection, oral gabapentin, and mirror therapy gave good results.

Conclusions: A preventive approach to phantom limb pain, in terms of surgical and non-surgical methods, might reduce the incidence of phantom limb pain and increase the quality of life among amputees.