Phantom pain - Current insights into its neuropathophysiology and therapy

The treatment of chronic phantom pain is quite varied and controversial, with nonsurgical methods being more successful than surgical intervention. The most promising methods in preventing phantom pain consist of epidural blockade before the operation to reduce preamputation pain or continuous postoperative regional anesthesia by nerve sheath blockade if the former is not feasible. The severity of the phantom pain should be assessed, along with the reason for the amputation, in order to plan an appropriate treatment. If mild, one should begin treatment with less invasive methods such as TENS and oral analgesics. As pain increases, subarachnoid fentanyl and epidural opioids, local anesthetics, or both may help to relieve the pain. Although not directly involved in the mechanism of phantom pain, the psychological status of the patient is an important consideration. The patient should be reassured that this phenomenon is real. Finally, the patient should also be informed that complete relief of pain may not be obtainable but that a reduction of pain is possible. As with any chronic pain process, the perceived pain intensity may be related to stress, anxiety, exhaustion, and depression.