Systematic review of percutaneous ablation for residual and phantom limb pain after amputation

This systematic review examined the efficacy and adverse outcomes of percutaneous ablation techniques — thermal radiofrequency ablation (RFA), pulsed RFA, and cryoablation — for post-amputation pain. The authors note that limb loss affects an estimated 176 million people globally, with up to 80% of patients experiencing significant residual limb pain (RLP) or phantom limb pain (PLP), conditions that typically respond poorly to conventional therapies.

The investigators searched Medline, Embase, PubMed, and Scopus on August 19, 2024 for English-language articles on ablation-based treatment of post-amputation pain. Risk of bias was assessed using the Joanna Briggs Institute tool for case reports and case series. Prespecified outcomes were response on standardized pain scales (numeric rating scale or visual analog scale), functional outcomes, and adverse events.

Of 1233 articles screened, 20 were included: 1 randomized controlled trial (n = 144 patients), 9 case series (n = 74), and 10 case reports (n = 10). In a pooled comparison across 3 studies (n = 32 patients), thermal RFA was associated with improvement in RLP versus baseline at 2 weeks, with a weighted mean difference of 7.0 (95% CI: 6.8–7.3). Findings for other ablation modalities, functional outcomes, longer-term follow-up, and adverse events were not reported in the available abstract text.

The evidence base is dominated by case reports and small case series, with only a single randomized trial and limited pooled data. Heterogeneity of study designs, small sample sizes for pooled analyses, and incomplete reporting of safety and durability in the abstract constrain clinical inference. Percutaneous ablation appears promising for post-amputation pain but should be considered within the context of limited high-quality comparative evidence.