Jaffee Stephen, Verma Rhea, Vaezi Mariam, Kite Trent, Tomycz Nestor
Department of Neurosurgery, Allegheny Health Network Neuroscience Institute, Pittsburgh, PA, USA.
Drexel University College of Medicine, Philadelphia, PA, USA.
Interv Pain Med. 2025 Mar 12;4(1):100571. doi: 10.1016/j.inpm.2025.100571. eCollection 2025 Mar.
Phantom limb pain (PLP) is a debilitating condition that affects individuals following limb amputation. While medical management with anticonvulsants and physical therapy is the first-line treatment, spinal cord stimulation (SCS) has emerged as an option for patients with persistent, refractory pain.
This study aimed to evaluate the current literature on SCS for PLP, focusing on pain reduction and associated complications.
A systematic review was conducted on reports of adults (≥18 years) with phantom limb pain treated with spinal cord stimulation. Titles and abstracts were screened, followed by a full-text review based on predefined inclusion criteria. Extracted data included sample size, SCS lead placement, pain reduction, visual analog scale (VAS) and brief pain inventory (BPI) scores, and complications. Descriptive statistics were used for analysis.
Five reports met inclusion criteria, comprising 33 patients. Of these, 18 % of patients achieved 90-100 % pain reduction, 15 % had ≥80 % reduction, 6 % had ≥60 % reduction, and 15 % experienced ≥50 % reduction. Post-SCS visual analog scores were reported in two studies; one study reported a mean 50 % reduction in visual analog scale scores (VAS), while another found a median brief pain inventory (BPI) reduction of 43.5 %. Complications across all 33 patients included wound infection (6 %), transient weakness (3 %), cerebrospinal fluid leak (3 %), allergic dermatitis (3 %), and electrode site cyst (3 %). Most patients (84.8 %) received epidural lead placement, while 15.2 % had subdural placement.
SCS may be effective in reducing pain in some PLP patients.However complications exist, with wound infection being the most common complication. The mechanism of action remains unclear, but PLP likely involves both central and peripheral pathology, which complicates treatment. Historically, SCS has shifted from subdural to epidural lead placement to minimize complications, with recent reports exploring dorsal root ganglion stimulation for more targeted pain relief. Spinal cord stimulation appears to provide meaningful pain reduction for patients with phantom limb pain, with a subset achieving near-complete relief. However, reported outcomes vary and complications remain a concern. Given the limited number of reports and small sample sizes, further research is needed to assess long-term efficacy and to minimize complications.
幻肢痛（PLP）是一种使人衰弱的病症，会影响截肢后的个体。虽然使用抗惊厥药物和物理治疗进行医学管理是一线治疗方法，但脊髓刺激（SCS）已成为持续性、难治性疼痛患者的一种选择。
本研究旨在评估当前关于SCS治疗PLP的文献，重点关注疼痛减轻情况及相关并发症。
对接受脊髓刺激治疗的成年（≥18岁）幻肢痛患者的报告进行系统综述。筛选标题和摘要，然后根据预定义的纳入标准进行全文审查。提取的数据包括样本量、SCS导联放置位置、疼痛减轻情况、视觉模拟量表（VAS）和简明疼痛量表（BPI）评分以及并发症。采用描述性统计进行分析。
五篇报告符合纳入标准，共33例患者。其中，18%的患者疼痛减轻90%-100%，15%的患者减轻≥80%，6%的患者减轻≥60%，15%的患者减轻≥50%。两项研究报告了SCS后的视觉模拟评分；一项研究报告视觉模拟量表评分（VAS）平均降低50%，而另一项研究发现简明疼痛量表（BPI）中位数降低43.5%。33例患者的并发症包括伤口感染（6%）、短暂性无力（3%）、脑脊液漏（3%）、过敏性皮炎（3%）和电极部位囊肿（3%）。大多数患者（84.8%）接受硬膜外导联放置，而15.2%的患者接受硬膜下放置。
SCS可能对部分PLP患者有效减轻疼痛。然而存在并发症，伤口感染是最常见的并发症。作用机制尚不清楚，但PLP可能涉及中枢和外周病理改变，这使治疗变得复杂。从历史上看，SCS已从硬膜下导联放置转变为硬膜外导联放置以尽量减少并发症，最近有报告探索背根神经节刺激以实现更有针对性的疼痛缓解。脊髓刺激似乎能为幻肢痛患者提供有意义的疼痛减轻，一部分患者可实现近乎完全缓解。然而，报告的结果存在差异，并发症仍然是一个问题。鉴于报告数量有限且样本量较小，需要进一步研究以评估长期疗效并尽量减少并发症。
