Central Nervous System Neuromodulation Techniques for Management of Phantom Limb Pain: A Review of Clinical Trials

Phantom limb pain (PLP) presents complex challenges in treatment, lacking standardized clinical approaches, and understanding its mechanisms remains elusive. Noninvasive brain stimulation (NIBS), specifically transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), seems promising in treating chronic pain, including PLP. These modalities can modulate neural activity, offering potential benefits by acting on interconnected neural networks beyond the stimulation site. Studies from Jan 1, 2003, to 2021 were reviewed on PubMed, Google Scholar, and the Web of Science using the keywords PLP, neuromodulation, transcranial direct current stimulation, transcranial magnetic stimulation, pain management, and their combinations. The language was limited to English. A single-session treatment has the potential to change the intensity of PLP for several hours. On the other hand, a multi-session treatment approach can decrease both the intensity and frequency of PLP for an extended period of several months. Additional research with a greater sample size and extended follow-up periods is necessary to determine the precedence of utilizing tDCS, rTMS and the potential for integration with other treatments for individuals with amputation experiencing PLP.