Introduction: Phantom limb pain (PLP) is a chronic neuropathic pain syndrome experienced by individuals following limb amputation. Despite the use of various pharmacological treatments, including opioids, antidepressants, and anticonvulsants, effective pain relief remains challenging for many patients. Motor cortex stimulation (MCS) has emerged as a promising alternative for managing PLP.
Methods: We present the management of three patients with chronic, refractory PLP who underwent epidural MCS at Lille University Hospital Center. The quadripolar electrode lead was implanted into the epidural space under local anesthesia. The target was determined by Stereotactic coordinates, and the optimal location was confirmed with the guidance of a three-dimensional brain magnetic resonance imaging reconstruction and neurophysiological testing. Pain intensity was assessed using the visual analog scale (VAS) at baseline and at the end of follow-up period, which had a mean duration of 7 ± 2.16 months.
Results: Two of the three patients experienced a decrease in pain by 50%, and one had a 44.4% reduction. The average preoperative VAS score significantly decreased from 7.0 ± 1.73 to 3.67 ± 1.15 at final follow-up (p = 0.00985). Initial stimulation settings included a pulse width of 45-60 µs, frequency of 45-60 Hz, and amplitude of 2-4 V. By the final follow-up, these parameters had been adjusted to 60-210 µs, 45-130 Hz, and 2-5.3 V, respectively. All patients reported a reduction in the amount of analgesic medications intake, and no major complications occurred.
Conclusion : PLP is one of the most challenging conditions to treat. MCS is an adjustable and reversible technique that appears to be effective in treating patients with this chronic pain syndrome refractory to other treatment modalities.
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