The prevalence rate for amputations is 26.3 per 100,000 (>50% due to peripheral vascular disease or diabetes). The incidence is 50 per 100,000. This is forecast to increase by 50% in the next 15 years. Only 43% of patients return to work. Phantom limb syndrome involves nociceptive pain, due to bone and soft tissue injury, and neuropathic pain from direct neural trauma and central sensitisation, as well as cortical changes that have led to a neuromatrix reorganization theory to explain phantom limb pain and phantom limb sensations.
Failure to optimise acute pain leads to a detrimental pathophysiological stress response, impacts on a patient’s psychology, functional recovery and predisposes to phantom limb syndrome1-6.
It is difficult to draw conclusions on the pharmacological management of phantom limb pain from trial evidence. The neuromatrix theory of phantom limb pain provides understanding as to why the management of phantom limb pain does not lie in pharmacology alone, rather in the multidisciplinary approach of surgical, pharmacological, physical therapy, prosthesis, psychological and behavioural interventions.
