Table 2.
Treatments proposed by experts for the management of PLP
| Proposed treatments | Percentage of experts who endorsed each treatment in round 2 | Percentage of experts who endorsed each treatment in round 3 | Consensus reached? (Yes/No) | Level of consensus * |
|---|---|---|---|---|
| Nonpharmacological treatments | ||||
| Mirror therapy | 75 | 80 | Yes | High |
| Graded motor imagery | 70 | 75 | Yes | High |
| Cognitive behavioral therapy | 70 | 75 | Yes | High |
| Use of a functional prosthesis | 70 | 75 | Yes | High |
| Sensory discrimination training | 60 | 60 | Yes | Low |
| Virtual reality training | 60 | 75 | Yes | High |
| TENS† | 45 | ‐ | No | ‐ |
| Residual limb muscle exercises | 45 | ‐ | No | ‐ |
| Acceptance and commitment therapy | 45 | ‐ | No | ‐ |
| Mindfulness | 40 | ‐ | No | ‐ |
| Pain neuroscience education | 40 | ‐ | No | ‐ |
| Imagined limb‐movement exercises | 40 | ‐ | No | ‐ |
| Residual limb massage | 40 | ‐ | No | ‐ |
| Postamputation counseling | 35 | ‐ | No | ‐ |
| Active listening | 35 | ‐ | No | ‐ |
| Peripheral nerve stimulation | 35 | ‐ | No | ‐ |
| Targeted muscle reinnervation | 30 | ‐ | No | ‐ |
| Residual limb bandaging | 30 | ‐ | No | ‐ |
| Sympathetic nerve block | 30 | ‐ | No | ‐ |
| Left/right judgments | 25 | ‐ | No | ‐ |
| Dorsal root ganglion stimulation | 25 | ‐ | No | ‐ |
| Prosthesis electromagnetic shielding | 25 | ‐ | No | ‐ |
| Electromyogram biofeedback training | 20 | ‐ | No | ‐ |
| Progressive residual limb‐muscle relaxation | 15 | ‐ | No | ‐ |
| Spinal cord stimulation | 15 | ‐ | No | ‐ |
| Pharmacological treatments | ||||
| Amitriptyline | 50 | 65 | Yes | Moderate |
| Pregabalin | 45 | ‐ | No | ‐ |
| Gabapentin | 40 | ‐ | No | ‐ |
| Morphine | 35 | ‐ | No | ‐ |
| Ketamine | 30 | ‐ | No | ‐ |
| Intraforaminal infusion of dilute lidocaine | 30 | ‐ | No | ‐ |
| Fluoxetine | 15 | ‐ | No | ‐ |
| NSAIDs | 15 | ‐ | No | ‐ |
| Surgery | ||||
| Peripheral nerve surgeries | 35 | ‐ | No | ‐ |
| Residual limb surgical revision | 15 | ‐ | No | ‐ |
*
The level of consensus is presented as low (≥50%‐60%), moderate (>60%‐70%), or high (>70%).
NSAID = nonsteroidal anti‐inflammatory drug; PLP = phantom limb pain; TENS = transcutaneous electrical nerve stimulation.