Transcranial direct current stimulation in the management of phantom limb pain: a systematic review of randomized controlled trials.
Víctor Navarro-López, Manuel Del-Valle-Gratacós, Diego Fernández-Vázquez and 3 others
PMID 35758072WHAT IT FOUND
Anodal tDCS over the primary motor cortex significantly reduced phantom limb pain intensity in adults with amputation.
Multi-session protocols (5-10 sessions) provided longer-lasting relief than single sessions. The effect was seen in both upper and lower limb amputees, regardless of how long ago the amputation occurred.
Key findings
01All included studies showed significant improvements in phantom limb pain favoring tDCS, either used alone or combined with mirror therapy.
02Multi-session protocols achieved reductions in pain intensity of approximately 40-50% that could last up to two months, whereas single sessions provided relief lasting only a few hours.
03tDCS did not significantly improve non-painful phantom limb sensations or psychiatric symptoms like depression and anxiety, which may require different treatment targets.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The review included only six studies with a total of 211 participants, which limits the generalizability of the findings. Meta-analysis was not possible due to heterogeneity in outcome measures and statistical reporting, so results are based on narrative synthesis. Some studies had concerns regarding blinding of participants and personnel, particularly those involving mirror therapy. The optimal parameters for stimulation (intensity, duration, placement) varied across studies, making it difficult to define a single standard protocol.
Declared interests
No conflicts of interest were reported by the authors.
The easy way to misread this
Do not assume tDCS will resolve all phantom limb symptoms. The review found that while pain intensity decreased, non-painful phantom sensations and psychiatric symptoms like depression and anxiety did not significantly improve with the same protocol used for pain.