Editing Phantom limb (section)

==Treatment==
Most approaches to treatment over the past two decades have not shown consistent symptom improvement. Treatment approaches have included [[medication]] such as [[antidepressants]], [[spinal cord]] stimulation, [[Oscillation|vibration]] [[physical therapy|therapy]], [[acupuncture]], [[hypnosis]], and [[biofeedback]].<ref>
{{cite journal | first1=Jens   | last1=Foell | first2=Robin | last2=Bekrater-Bodmann | first3=Herta | last3=Flor | first4=Jonathan | last4=Cole | title=Phantom Limb Pain After Lower Limb Trauma: Origins and Treatments | journal= The International Journal of Lower Extremity Wounds| date=December 2011 | volume=10 | issue=4 | pages=224–235 | doi=10.1177/1534734611428730| pmid=22184752 | s2cid=1182039 }}</ref> Reliable evidence is lacking on whether any treatment is more effective than the others.<ref>{{Cite journal|last1=Alviar|first1=Maria Jenelyn M.|last2=Hale|first2=Tom|last3=Dungca|first3=Monalisa|date=2016-10-14|title=Pharmacologic interventions for treating phantom limb pain|journal=The Cochrane Database of Systematic Reviews|volume=10|issue=8 |pages=CD006380|doi=10.1002/14651858.CD006380.pub3|issn=1469-493X|pmid=27737513|pmc=6472447}}</ref>
[[File:Ramachandran-mirrorbox.svg|thumb|280x280px|A mirror box used for treating phantom limbs, developed by V.S. Ramachandran]]
Most treatments are not very effective.<ref>{{cite journal | last1=Flor | first1=H | last2=Nikolajsen | first2=L | last3=Jensn | first3=T | title=Phantom limb pain: a case of maladaptive CNS plasticity? | journal=Nature Reviews Neuroscience | volume=7 | issue=11 | date=November 2006 | pages=873–881 | url=http://krieger.jhu.edu/sebin/s/u/Flor_et_al_2006.pdf | doi=10.1038/nrn1991 | pmid=17053811 | s2cid=2809584 | access-date=2012-04-16 | archive-url=https://web.archive.org/web/20120722014045/http://krieger.jhu.edu/sebin/s/u/Flor_et_al_2006.pdf | archive-date=2012-07-22 | url-status=dead }}</ref> [[Ketamine]] or [[morphine]] may be useful around the time of surgery.<ref name=Mc2014/> Morphine may be helpful for longer periods of time.<ref name=Mc2014/> Evidence for [[gabapentin]] is mixed.<ref name=Mc2014>{{cite journal|last1=McCormick|first1=Z|last2=Chang-Chien|first2=G|last3=Marshall|first3=B|last4=Huang|first4=M|last5=Harden|first5=RN|title=Phantom limb pain: a systematic neuroanatomical-based review of pharmacologic treatment.|journal=[[Pain Medicine (journal)|Pain Medicine]]|date=February 2014|volume=15|issue=2|pages=292–305|pmid=24224475|doi=10.1111/pme.12283|doi-access=free}}</ref> [[Perineural catheter]]s that provide [[local anesthetic]] agents have poor evidence of success when placed after surgery in an effort to prevent phantom limb pain.<ref name=Bos2015>{{Cite journal  | last1 = Bosanquet | first1 = DC. | last2 = Glasbey | first2 = JC. | last3 = Stimpson | first3 = A. | last4 = Williams | first4 = IM. | last5 = Twine | first5 = CP. | title = Systematic Review and Meta-analysis of the Efficacy of Perineural Local Anaesthetic Catheters after Major Lower Limb Amputation. | journal = Eur J Vasc Endovasc Surg | volume =  50| issue =  2| pages =  241–9|date=Jun 2015 | doi = 10.1016/j.ejvs.2015.04.030 | pmid = 26067167 | doi-access = free }}</ref>

One approach that has received public interest is the use of a [[mirror box]]. The mirror box provides a reflection of the intact hand or limb that allows the patient to "move" the phantom limb, and to unclench it from potentially painful positions.<ref name = Ramachandran1995>{{cite journal | author = Ramachandran, V. S., Rogers-Ramachandran, D. C., Cobb, S. |year=1995 |title=Touching the phantom |journal=[[Nature (journal)|Nature]] |volume=377 |pages=489–490 | pmid = 7566144 |doi=10.1038/377489a0 |issue=6549|s2cid=4349556 }}</ref><ref name = Ramachandran1996>{{cite journal | author = Ramachandran, V. S., Rogers-Ramachandran, D. C. |year=1996 |title=Synaesthesia in phantom limbs induced with mirrors |url= http://psy.ucsd.edu/chip/pdf/Synsth_Phant_Lmb_P_Roy_Soc.pdf |journal=[[Proceedings of the Royal Society of London B]] |volume=263 |issue=1369 |pages=377–386 | pmid = 8637922 |doi=10.1098/rspb.1996.0058|bibcode=1996RSPSB.263..377R |s2cid=4819370 }}</ref>

Although mirror therapy was introduced by [[VS Ramachandran]] in the early 1990s, little research was done on it before 2009, and much of the subsequent research has been of poor quality, according to a 2016 review.<ref>{{cite journal |title=The effects of mirror therapy on pain and motor control of phantom limb in amputees: A systematic review |journal=[[Annals of Physical and Rehabilitation Medicine]] |volume=59 |date=September 2016 |pages=270–275 |quote=" "The level of evidence is insufficient to recommend MT as a first intention treatment for PLP"" |doi=10.1016/j.rehab.2016.04.001 |author=Barbin J., Seetha V., Casillas J.M., Paysant J., Pérennou D. |issue=4 |pmid=27256539|doi-access=free }}</ref> A 2018 review, which also criticized the scientific quality of many reports on mirror therapy (MT), found 15 good-quality studies conducted between 2012 and 2017 (out of a pool of 115 publications), and concluded that "MT seems to be effective in relieving PLP, reducing the intensity and duration of daily pain episodes. It is a valid, simple, and inexpensive treatment for PLP."<ref name="2018ReviewMT">{{cite journal |last1= Campo-Prieto|first1= P|last2=Rodríguez-Fuentes |first2= G|date= November 14, 2018|title= Effectiveness of mirror therapy in phantom limb pain: A literature review|journal= Neurologia |volume= 37|issue= 8|pages= 668–681|doi= 10.1016/j.nrl.2018.08.003|pmid= 30447854|quote=It is a valid, simple, and inexpensive treatment for PLP. The methodological quality of most publications in this field is very limited, highlighting the need for additional, high-quality studies to develop clinical protocols that could maximise the benefits of MT for patients with PLP. |doi-access= free|hdl= 11093/7746|hdl-access= free}}</ref>