Treatment of phantom limb pain - an evidence-based overview for clinical practice

MMW Fortschr Med. 2026 Apr;168(Suppl 3):19-26. doi: 10.1007/s15006-026-5643-2.

ABSTRACT

BACKGROUND: Phantom limb pain (PLP) is a frequent and often severely distressing complication following limb amputation. Despite a broad range of available therapeutic approaches, its treatment remains clinically challenging. Many interventions demonstrate only limited or short-term effectiveness, and evidence from high-quality clinical trials is scarce for several established methods.

METHODS: This narrative review provides a clinically oriented overview of current pharmacological, physical, and psychological treatment strategies.

RESULTS: Particular attention is given to prolonged peripheral nerve blocks, which have shown the most consistent therapeutic benefit in both preventive and therapeutic contexts. In addition, anticonvulsants such as pregabalin and gabapentin are among the few medications with controlled data supporting their use in PLP. Non-drug interventions like mirror therapy and transcutaneous electrical nerve stimulation (TENS), as well as psychological approaches including hypnosis and trauma-focused therapy, may offer additional benefit within multimodal frameworks, though their evidence remains limited. In contrast, other therapies, including tricyclic antidepressants, cryoneurolysis, or botulinum toxin, currently lack sufficient supporting data.

CONCLUSIONS: Given the heterogeneous nature of the underlying pathophysiology and the variability in patient response, an individualized, evidence based and multimodal treatment concept appears to be the most practical and effective approach for managing phantom limb pain in clinical practice.

PMID:41991877 | DOI:10.1007/s15006-026-5643-2