Do neuroprosthetics reduce phantom limb pain?

Introduction Phantom limb pain (PLP) is a common and debilitating condition affecting a large proportion of amputees and is associated with maladaptive cortical plasticity. Neuroprosthetic interventions may restore sensorimotor integration and thereby reduce PLP. This systematic review aimed to evaluate whether different neuroprosthetic approaches reduce PLP and to identify which modalities demonstrate the greatest pain reduction. Methods This review was conducted in accordance with PRISMA guidelines. Eligible studies investigated upper-limb amputees receiving neuroprosthetic interventions, specifically Transverse Intrafascicular Multichannel Electrodes (TIME), virtual augmented reality (VAR) or myoelectric prostheses. Phantom limb pain was assessed using the Visual Analogue Scale (VAS) before and after the intervention with specialist training. Results Seven observational studies comprising 32 participants met the inclusion criteria. Overall, 87.5% of participants demonstrated a reduction in VAS scores following intervention. All included studies reported a mean decrease in PLP following neuroprosthetic use, with the largest reductions observed in studies involving TIME electrodes and VAR-based interventions. However, effect sizes varied considerably across studies. Conclusion The findings suggest that neuroprosthetic interventions may be associated with reductions in phantom limb pain; however, the evidence remains preliminary. Small sample sizes, study heterogeneity, and reliance on observational designs limit the strength of conclusions. Further high-quality, longitudinal studies are required to establish efficacy and inform clinical implementation.