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Somnolence occurred more frequently in the gabapentin arm compared to the placebo arm, but the results were not statistically significant.⁷Īnother placebo-controlled, double-blind crossover trial involving 24 patients and lasting 5 weeks, found no difference in pain intensity (primary outcome) between placebo and treatment with up to 3600 mg of gabapentin, mean numerical rating scale ± SD (3.60 ± 2.67 versus 3.43 ± 2.54). Participants reported few adverse events, such as dizziness, headache, nausea, and somnolence. Although the mean ± SD PID was significantly greater in the gabapentin group (3.2 ± 2.1 versus 1.6 ± 0.7) during Week 6, there was no impact on activities of daily living. Subjects received up to 2400 mg of gabapentin daily during a gabapentin phase.⁶ The primary endpoint was pain intensity difference (PID) compared with baseline at the end of each treatment. The efficacy of the anticonvulsant gabapentin in the treatment of PLP was studied in a double-blind, placebo-controlled crossover study consisting of 19 patients. (Source: Shutterstock) Anticonvulsants: Gabapentin The lack of clinical guidelines for phantom limb pain makes it difficult to prioritize treatments. It is also worth pointing out that nonpharmacologic measures have been studied in the management of phantom limb pain, including transcutaneous electrical nerve stimulation (TENS), mirror therapy, deep brain stimulation, acupuncture, relaxation, and biofeedback.³⁻⁵ In this review, however, we will focus on the numerous pharmacologic therapies used in the management of phantom limb pain. Given that most amputations in the United States are performed due to vascular disease,¹˒³ it is important for healthcare providers to become aware of various treatment options for PLP and their efficacy. Rather than supporting one pain control method over another, the guidelines recommend a multimodal approach involving both pharmacologic and nonpharmacologic therapies.³ However, there is insufficient evidence for pharmacologic interventions that effectively reduce PLP after amputation.¹⁻⁵ In addition, there are no specific guidelines for the management of PLP however, the US Department of Veterans Affairs and Department of Defense have issued guidelines on the rehabilitation of lower limb amputation which include a segment on pain management. The etiology and pathophysiology of PLP are not well understood, but the condition is thought to be multifactorial and to involve both the peripheral and central nervous systems.²˒⁵This proposed pathophysiology has led to treatment of PLP with those drugs commonly used for neuropathic pain, such as antidepressants, opioids, anticonvulsants, N-methyl-D-aspartate (NMDA) receptor antagonists, and anesthetics.