title: Phantom limb pain in daily practice--still a lot of work to do!
abstract: OBJECTIVE
  Effective treatment of phantom limb pain (PLP, pain felt in the part of the body of an amputated limb) is still difficult to achieve, and improved treatment is needed. It is therefore of paramount interest to understand the current practice of PLP therapy outside pain centers.
  
  
  METHODS
  As a part of a nationwide survey, 537 amputees were asked 11 questions related to their treatment experiences and the pain relief. Furthermore, the patients' opinion about the quality of medical care was also asked.
  
  
  RESULTS
  Five hundred thirty-seven out of 1088 amputees returned the questionnaire (49.4%). Four hundred (74.5%) suffered from PLP. The patients rated their caregivers' knowledge about PLP lower than their own. Many (41.6%) of PLP patients had never been informed about the possibility of occurrence and mechanisms of PLP. The vast majority of the PLP patients did not try any treatment. Among those treated, more than 30% consulted more than three physicians for beneficial treatment. A >50% pain reduction was achieved in only 12.7% of PLP patients. The most successful treatments were opioids (67.4%) and anticonvulsants (51.7%). Surgery was performed in 46.4% of all PLP patients and in 29.7% due to a clinically suspected neuroma. After surgery, pain was worse or unchanged in 50% and improved in 41.6%, and 7.4% were pain-free.
  
  
  CONCLUSIONS
  Our results suggest that there are primary needs for better information about PLP pathophysiology and treatment not only for patients but also for caregivers. Limited therapeutic success reveals a further need for increased research in PLP management.
authors.affiliation: Center for Pain Management and Palliative Care, Wiesbaden, Germany. dr.kern@schmerzzentrumwiesbaden.de
authors.forename: Uwe
authors.initials: U
authors.lastname: Kern
authors.forename: Volker
authors.initials: V
authors.lastname: Busch
authors.forename: Ruben
authors.initials: R
authors.lastname: Müller
authors.forename: Matthias
authors.initials: M
authors.lastname: Kohl
authors.forename: Frank
authors.initials: F
authors.lastname: Birklein
mesh_terms: D000328:Adult; D000672:Amputation Stumps / Q000601:surgery; D000674:Amputees / Q000523:psychology*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D002983:Clinical Competence / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010591:Phantom Limb / Q000523:psychology / Q000628:therapy*; D011787:Quality of Health Care; D012064:Relaxation Therapy / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D004561:Transcutaneous Electric Nerve Stimulation / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000927:Anticonvulsants