Current and future options for the management of phantom-limb pain

Figures & data

Table 1 Level of evidencea for the drugs utilized to treat phantom-limb pain and other neuropathic-pain conditions

Drug	Neuropathic-pain conditions
	PLP	PPN	PHN	TN	HIV	CP
Acetaminophen	CrS/P
NSAIDs	CrS/P
Antidepressants tricyclics
Amitriptyline	CT/P/N	CT/Pb	CT/Pb		CT/N	CTb
Desipramine		CT/Pb	CT/Pb			b
Imipramine		CT/Pb,	CT/Pb			b
Nortriptyline		CT/Pb	CT/Pb			b
Clomipramine		CT/Pb	CT/Pb
Trazadone		CT/P
Maprotiline		CT/Pb	CT/Pb			b
Tetracyclics
Mirtazapine	CS
SSRIs
Escitalopram		CT/P
Fluoxetine		CT/P
Paroxetine		CT/P
Sertraline		OLT/P
Bupropion		CT/P	CT/P
SNRIs
Duloxetine	CR	CT/Pb
Venlafaxine ER	CT/N	CT/Pb				CT/P
Milnacipran	CR
Anticonvulsants calcium channel alpha 2 delta ligands
Gabapentin	CT/P	CT/P/Nb	CT/Pb	CR	CT/N	CT/Pb
Pregabalin	CT/P	CT/Pb	CT/P		CT/N	CT/Pb
Carbamazepine		CT/P		CT/Pb
Lamotrigine		CT/P/N				CT/P/N
Oxcarbamazepine				CT/Pb
Phenytoin		CT/P/N
Topiramate		CT/P/N
Valproate		CT/P/N	CT/P			CT/N
Sodium channel blockers
Bupivacaine (inject)	CT/P
Lidocaine
Infusion	CT/N	CT/P
Patches			CT/P
Mexiletine		CT/P/N			CT/N	CT/N
NMDA receptor antagonists
Memantine	CR/P/N	CT/P/N	CT/N
Ketaminec	CT/N
Dextromethorphan		CT/P	CT/N
NMDA+Potassium channel blocker					CR
Flupirtine (plus opioids)
Opioids
Morphine	CT/P	CT/P	CT/P
Methadone	CS
Buprenorphined	CR/P
Oxycodone	CR/P	CT/P	CT/P
Levorphanol		CT(M)
Tramadol	CT/P	CT/P	CT/P
Muscle relaxants
Baclofen	CRd		CT/P
Benzodiazepines
Clonazepam	CS
Diazepam		CT/P
Alprazolam		OLT
Corticosteroids
Prednisone		CS
Dexamethasone		CS
Capsaicin		CT/P/N	CT/P	CT/N

Notes: In bold characters, reports and studies specifically designed to test drugs on PLP.

a Only highest level of evidence for each drug and condition reported;

b first-line drugs according to EFNS guidelines;

c intravenous infusion;

d intrathecal analgesia.

Abbreviations: CrS, cross-sectional study; CR, case report/case series; CT, controlled trial; OLT, open label trial; M, mixed patient population; P, positive clinical trial; N, negative clinical trial; P/N, mixed clinical trial results; PLP, phantom limb pain; PPN, painful polyneuropathy; PHN, post-herpetic neuralgia; TN, trigeminal neuralgia; CP, central pain (post-stoke and spinal cord injury); NSAIDs, nonsteroidal anti-inflammatory drugs; SSRIs, selective serotonin reuptake inhibitors; SNRIs, serotoninnorepinephrine reuptake inhibitors; NMDA, N-Methyl-D-Aspartate.

Figure 1 Lateral x-ray of the skull documenting the position of the implanted paddle leads. Matching of postoperative ct-scan and preoperative MRI-3D-neuronavigation data with inserted position of the leads over the pre- and postcentral gyrus.