June 20, 2026
Currently, there is no gold standard treatment for phantom limb pain (PLP) in people with limb loss.
"Phantom limb pain remains incredibly common, affecting roughly two-thirds of individuals with limb loss, and it can be one of the biggest barriers to meaningful functional recovery," says F. Clay Smither, M.D., a physiatrist and chair of Physical Medicine and Rehabilitation at Mayo Clinic in Rochester, Minnesota. He specializes in helping people with limb loss adjust to prosthetic devices and return to everyday activities.
PLP often causes involuntary muscle contractions, making it hard for patients to control their prostheses. As a result, many patients are unable to tolerate their prostheses, preventing functional use of the affected limbs.
Medications and physical and occupational therapy are often the first line treatments of choice. However, these options have limited effects, and no single treatment is universally effective for PLP.
When first line medications and therapies prove insufficient, physicians may consider surgical options including spinal cord stimulation (SCS).
To evaluate this approach, Dr. Smither and others at Mayo Clinic explored the potential of SCS for severe phantom limb pain. The case study was published in Frontiers in Pain Research.
A case study on spinal cord stimulation for phantom limb pain
A 52-year-old male patient presented with PLP following a transhumeral amputation with concurrent targeted muscle reinnervation.
Despite trialing several medications and pain management therapies, including physical and occupational therapy, PLP severity continued to increase. The patient reported a numeric rating scale (NRS) pain score of 9/10 and was able to tolerate his myoelectric prosthesis for only three hours a day.
Through the recommendation of Mayo Clinic pain management specialists, the patient elected to undergo SCS.
Doctors implanted a high-frequency spinal cord stimulator with bilateral leads positioned at the C1-C2 vertebral levels. To mitigate the risk of stimulation-induced paresthesia in the upper extremities — a known adverse effect of SCS — they programmed the device to 10,000 Hz.
At the 12-day postoperative follow-up, the patient reported a:
- 70% improvement in average pain intensity and an NRS score of 0/10.
- 70% improvement in overall function, which included longer uninterrupted periods of sleeping, sitting, and reading and retaining more information.
- Tolerance of his myoelectric prosthesis for up to 17 hours a day.
These improvements held over the long term. At the two-year follow-up, the patient reported an NRS score of 0/10 and wore his prosthesis daily.
"Pain improved dramatically and with that came better muscle control, which is critical for using a myoelectric prosthesis," Dr. Smither says. "It really reinforces that if we can effectively treat pain, we can unlock the full potential of these advanced technologies."
High-frequency spinal cord stimulation as a paresthesia-free approach to chronic pain
The outcomes observed in this case study reflect a broader shift toward high-frequency, paresthesia-free technology for treating chronic and neuropathic pain.
This case study builds on earlier research by Jon M. Hagedorn, M.D., a pain medicine specialist at Mayo Clinic in Rochester, Minnesota.
In a review article in Biomedicines, Dr. Hagedorn and his team determined that high-frequency SCS — a newer technology — has a meaningful advantage over traditional low-frequency SCS for treating chronic and neuropathic pain.
Whereas low-frequency SCS creates paresthesia to mask pain, the high-frequency device provides pain relief without paresthesia.
"What our case adds is a clear functional outcome: showing how effective pain control can directly enable sustained, real-world use of advanced myoelectric prostheses," Dr. Smither says.
He notes that future research should focus on understanding the underlying mechanism of phantom limb pain and how SCS works. It also should prioritize standardized functional outcomes and not just pain scores to better capture meaningful improvements in quality of life.
"Ultimately, the opportunity is to develop more-integrated models of care that combine neuromodulation, surgical techniques and advanced prosthetic design to optimize outcomes for patients with limb loss," Dr. Smither says.
For more information
Penz LE, et al. Case report: Spinal cord stimulation for phantom limb pain facilitates upper limb myoelectric prosthesis use. Frontiers in Pain Research. 2026;7:1751694.
Tieppo Francio V, et al. Management of chronic and neuropathic pain with 10 kHz spinal cord stimulation technology: Summary of findings from preclinical and clinical studies. Biomedicines. 2021;9:644.
Refer a patient to Mayo Clinic.