If first-line medications to treat phantom limb pain (PLP) are not effective, surgical treatment options including spinal cord stimulation may be considered. Researchers detailed a case of PLP after transhumeral amputation with targeted muscle reinnervation.
The pain was complicated by involuntary muscle contractions in the patient’s residual limb, which was a barrier to effective myoelectric prosthetic limb use. After trying several medications for neuropathic pain and a stellate ganglion block with insufficient pain relief, the patient received a cervical spinal cord stimulator. At follow-up, the patient reported 70 percent improvement in pain and 70 percent improvement in function, including improvements in sitting, sleeping, reading, and recovery after activity.
In addition, the patient’s prosthetic limb use increased from about three hours per day to 17 hours per day.
Effective treatment of post-amputation pain is especially important for patients with myoelectric prostheses who rely on controlled muscle activation for limb function. There is evidence to support that a myoelectric prosthesis may decrease PLP, another reason that reducing barriers to prosthetic limb use is imperative, the study said.
In summary, the researchers concluded that the benefit of spinal cord stimulation for the treatment of PLP extends beyond decreasing subjective pain intensity, and future research and clinical intervention should include functional outcome measures,.
