Comparative analysis of the effectiveness of additional non-drug treatments for phantom pain at the first stage of medical rehabilitation

Introduction. Phantom pain syndrome (PPS) affects approximately 85 % of patients after amputation and inhibits active participation in rehabilitation, critically reducing its effectiveness. Current treatment methods are insufficiently effective. The increasing incidence of traumatic amputations, including those resulting from mine blast injuries, requires the development of reliable PPS treatment protocols that incorporate non-pharmacological methods implemented within a multidisciplinary rehabilitation team.

The objective was to compare the effectiveness of additional non-pharmacological treatments for PPS during the first stage of rehabilitation of patients with traumatic amputation.

Methods and materials. A total of 166 patients with traumatic amputations participated in this prospective, randomized study. The control group included patients who received only basic PPS therapy during the first stage of rehabilitation: gabapentin, exercise therapy, and tight bandaging. Four experimental groups comprised patients who additionally received 10 sessions of the following for two weeks: transcranial electrical stimulation (TES); psychotherapy (PSI); simultaneous PSI and TES; and mirror therapy (MT). The dynamics of PPS were assessed.

Results. The additional methods demonstrated greater effectiveness compared to the control group: significant improvement (3 or more VAS points) was noted in 57 % of patients versus 22 %, moderate improvement (<3 points) in 35 % versus 56 %, and deterioration in 8 % versus 22 %. Linear mixed model analysis revealed a statistically and clinically significant difference in PPS dynamics in the experimental groups compared to the control group (F (16, 423.013)=3.542; Partial η²=0.118; p < 0.001).

Conclusions. Additional non-pharmacological treatments for PPS, such as TES, PSI, and MT, significantly improve its course during the early stages of medical rehabilitation. Further research should focus on understanding the factors that contribute to the development of PPS, identifying indications for specific treatments, and personalizing PPS treatment protocols.

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