Adaptive stimulation as a method for reducing phantom pain in amputeated limbs

This paper presents a comprehensive analysis of the neurobiological and physiological mechanisms underlying phantom limb pain following limb amputation, as well as contemporary stimulation-based approaches for its management. Phantom limb pain is considered as a multilevel phenomenon involving peripheral nerve hyperexcitability in the stump, spinal sensitization, and central mechanisms, including cortical and thalamocortical reorganization and the phenomenon of sensorimotor incongruence. The mechanisms of action of noninvasive cognitive interventions, such as mirror therapy and virtual reality, are analyzed alongside physical and electrical stimulation methods (TENS, vibration therapy, peripheral nerve stimulation), as well as invasive neuromodulation and surgical interventions, including targeted muscle reinnervation and targeted sensory reinnervation. It is shown that the effectiveness of phantom limb pain treatment largely depends on matching the selected intervention to the dominant pathophysiological mechanism in a given patient. A differentiated, mechanism-oriented approach to the selection of stimulation methods is proposed, integrating peripheral, spinal, and central strategies of intervention. The presented findings may be applied to optimize post-amputation rehabilitation and to advance the development of modern neuromodulation systems.