Phantom limb pain: peripheral neuromodulatory and neuroprosthetic approaches to treatment

Abstract

Post-amputation phantom limb pain (PLP) is a wide-spread phenomenon that can have physical, psychological, andfunctional impacts on amputees who experience the condition.The varying presentations and mechanisms of PLP make it diffi-cult to effectively provide long-term pain relief. Multiple neuromo-dulatory approaches to treating PLP have focused on electricalstimulation of the peripheral nervous system, with varyingdegrees of success. More recently, research has been done tostudy the effects of neuroprosthetic approaches on PLP. Neuro-prosthetics combine the use of a functional prosthetic with stimu-lation to the peripheral nerves in the residual limb. Although manyof the neuroprosthetic studies focus on improving function, sev-eral have shown preliminary evidence for the reduction of severityof PLP. In this review we provide an overview of the currentunderstanding of the neurological mechanisms that initiate andsustain PLP, as well as the neuromodulatory and neuroprostheticapproaches under development for treatment of the condition.