The Efficacy of Cognitive Behavioural Therapy in Reducing Phantom Limb Pain in amputee patients: A Systematic Review

Abstract

Background: Amputations can result in alterations of both Central Nervous System (CNS) and Peripheral Nervous System (PNS). Frequently it gives rise to Phantom Limb Sensations (PLS) as well. Amputees who experience intense pain over the amputated limb are known as Phantom Limb Pain (PLP). PLP is manifested with sharp stabbing, tingling, cramps, throbbing, and immobile limb sensations. Numerous modal treatment approaches are used, including analgesics, vasodilators, muscle relaxants, sympathetic blocks, surgical revision of the stump, sympathectomies, mirror box therapy, and stimulation-induced analgesia techniques. Predominantly, conservative management is still preferred for treating PLP, and it has exhibited a positive outcome. Cognitive behavioral therapy (CBT) is one of the conventional treatments proved to lessen PLP.

Objective: The study aims to investigate the efficacy of cognitive behavioral therapy in reducing phantom limb pain for amputee patients.

Methods: A systematic review of all randomized controlled trials (RCTs) articles related to cognitive behavioral therapy and amputees with phantom limb pain. The search covered from January 2012 to September 2021 from 7 electronic databases (i.e., PubMed, PubMed Central, Cochrane Library, ClinicalKey, PEDro, SciELO, and Google Scholar). All studies contain information regarding the efficacy of cognitive behavioral therapy in reducing phantom limb pain for amputee patients.

Results: Out of 258 selected articles, 127 articles remained after duplicates removed. A total of 59 studies were excluded due to inability to fulfil the inclusion criteria, and 68 studies remained after studying their titles and abstracts. Subsequently, another 32 studies were excluded after the full-text screening for reasons of no primary outcome, no control, or comparison group. Finally, 39 articles were selected for this study that met the desired inclusion criteria. Further, 7 articles that meet the criteria were included upon further analysis, and 32 articles were then excluded. The eligible studies' analysis revealed that mirror therapy was the most effective intervention in reducing phantom limb pain among various modalities of CBT.

Conclusion: This study concluded that CBT includes mirror therapy (MT), virtual reality (VR) therapy, and other types of intervention such as transcutaneous electrical nerve stimulation (TENS), mental imagery techniques, tactile treatment, and phantom limb exercise can be used in reducing PLP. However, MT was the most effective intervention in comparison with other modalities.