Thank you for your interest in phantom limb pain management. It is true that the original article did not detail the specific pharmacologic options, but as you noted, gabapentinoids, tricyclic antidepressants, and selective norepinephrine reuptake inhibitors are indeed commonly used agents for the management of neuropathic pain. Clinically, topical agents may be more effective for allodynia or hyperaesthesia. Injection options include corticosteroids, botulinum neurotoxin, and phenol (chemical nerve ablation) or thermal (radiofrequency or cryo) disruption of nerves.
A specific goal in writing this brief review was to encourage clinicians to look for and identify root causes of pain, as this may lead to focal, specific, and sometimes more definitive treatment of phantom limb pain. A symptomatic neuroma is only one of several causes of phantom limb pain that may be amenable to focal treatment. Recently, a patient’s phantom upper limb pain dissipated with a trigger point injection into the ipsilateral levator scapula!
I agree that it is relevant and important to screen for depression, anxiety, and posttraumatic stress, as this is always a part of the holistic approach to managing pain. For amputees, a thorough evaluation of phantom limb pain includes a review of prosthetic, biomechanical, anatomic (neuromusculoskeletal and vascular), metabolic, and psychologic function. Having a team approach allows for the breadth of skills required to address the initiating and perpetuating factors leading to phantom limb pain.
—Rhonda Willms, MD
This letter was submitted in response to “Re: Phantom limb pain.”
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