An overview of current and emerging strategies for phantom limb pain

INTRODUCTION: Phantom limb pain (PLP) is a disabling neuropathic pain syndrome affecting many individuals following limb amputation. Despite decades of research, PLP management remains challenging because of its complex and incompletely understood pathophysiology. AREAS COVERED: According to the SANRA recommendations, this updated narrative review provides a critical overview of current pathophysiological concepts and clinically relevant established and emerging therapeutic strategies for PLP. Relevant literature was identified through searches of PubMed/MEDLINE, Scopus, and Web of Science databases using predefined combinations of terms related to PLP. The review integrates evidence from pharmacological studies, rehabilitation trials, neuromodulation research, and emerging digital-health applications. EXPERT OPINION: PLP should be considered a biologically heterogeneous pain condition associated with multiple potential mechanisms, including peripheral, spinal, central, and psychosocial factors. Current evidence suggests that the relative contribution of these mechanisms varies across individuals, and no single mechanism adequately explains all cases of PLP. Conventional pharmacological strategies provide limited and inconsistent benefit, whereas multimodal interventions combining sensorimotor rehabilitation, neuromodulation, psychological support, and targeted surgical approaches are promising. Future progress will likely depend on mechanism-based phenotyping, integration of artificial intelligence, brain-computer interfaces, and closed-loop neuromodulation systems to enable personalized management strategies. However, high-quality studies with standardized outcome measures and long-term assessments are urgently needed.