Impact of Repetitive Transcranial Magnetic Stimulation Versus Drug Therapy on Phantom Limb Pain in Traumatic Lower Limb Amputees: A Randomized Controlled Trial

J Surg Res. 2026 May 28;324:144-154. doi: 10.1016/j.jss.2026.05.003. Online ahead of print.

ABSTRACT

INTRODUCTION: Amputation causes significant reorganization in the motor and somatosensory cortex. Phantom limb pain (PLP) is a disorder characterized by pain in the missing limb that can persist for years. The treatment of PLP includes both pharmacological and nonpharmacological options. The study aimed to examine the effects of repetitive transcranial magnetic stimulation (rTMS) compared with drug therapy (DT) on PLP.

METHODS: The patients were randomized to rTMS and DT groups within 24 h of amputation. Ten sessions of rTMS therapy, each lasting for 15 min at a frequency of 1 Hz over the left motor cortex for 2 wk, were compared with monitored drug dispensing over 3 wk for PLP management. The patients were assessed for serotonin 5-hydroxytryptamine, Numerical Rating Scale, McGill Pain Questionnaire, Hospital Anxiety and Depression Scale, and Clinical Global Impression (CGI) score until 8 wk postamputation.

RESULTS: A total of 50 patients were enrolled in the study, with 24 in the rTMS group and 26 in the DT group. The mean age in the rTMS group and the DT group was 36 ± 2.7 and 34.5 ± 2.3, respectively. Both groups had only one female patient each. Road traffic injuries were the most common causes of mechanism of injury in both the groups. Above knee amputation was the most common site of amputation. The results of serotonin 5-hydroxytryptaminesuggested that both the managements are equally effective with a P value of 0.08. Pain scores (Numerical Rating Scale and McGill Pain Questionnaire) and psychological well-being (Hospital Anxiety and Depression Scale) scores showed similar results. In the Clinical Global Impression score, the overall domain showed a better result in the rTMS group than in the DT group.

CONCLUSIONS: The results are suggestive of the use of low-frequency rTMS as an alternative method for managing PLP at the onset of symptoms in traumatic amputees and thus reducing dependency on medications.

PMID:42208213 | DOI:10.1016/j.jss.2026.05.003