Sensory Retraining for Phantom Limb Pain

Inclusion criteria

• Living in the UK
• All Genders
• Aged ≥18 years of age
• Women who self-declare:
• that they are post-menopausal, or permanently sterile*,

• or -
• that it is physiologically impossible that they could be pregnant and not be aware they are.

Women who do not make one of the two declarations above, are only eligible if:

• they undertake a highly sensitive urine pregnancy test which is negative, prior (and as close in time as is possible) to beginning the treatment phase of the Trial,
• and -
• they agree to use a highly, or acceptably effective, contraceptive measure** during the treatment phase of the Trial.

• fully healed residual limb (or stump) ***
• single or multi limb amputation with the intervention applied to the participants limb of choice
• experienced PLP rated as ≥4 on a 0-10 scale on at least 2 days in the week prior to enrolment
• agree to inform us of the use of any new (to them) prescribed drug for their pain during the trial
• any prescribed pharmacological treatment for the treatment of PLP stable for one month prior to commencing the trial , and agree not to undertake any non-pharmacological treatments for their PLP during the trial (e.g., mirror therapy)
• agree to inform us of any other health care received related to the amputated limb during the trial (e.g., physiotherapy or occupational therapy) whether specific to PLP or not
• any previous non-pharmacological PLP treatment must have terminated at least 1 month prior to commencing the trial
• Participants will need access to a mobile smart phone and a device (laptop, iPad etc.) at home to receive text messages and take part in secure video conference calls and completion of online forms.

*Post menopause is defined as no menses for 12 months without an alternative medical cause. Permanently sterile methods include hysterectomy, bilateral salpingectomy, and bilateral oophorectomy

**Highly effective contraceptive methods being:

• Combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation either oral, intravaginal, or transdermal
• Progestogen only hormonal contraception associated with inhibition of ovulation, either oral, injectable, or implantable
• Intrauterine device IUD
• Intrauterine hormone-releasing system IUS
• Sexual abstinence

Acceptably effective contraceptive methods being:

• Progestogen-only oral hormonal contraception, where inhibition of ovulation is not the primary mode of action
• Male or female condom with or without spermicide
• Cap, diaphragm or sponge with spermicide
• A combination of male condom with either cap, diaphragm or sponge with spermicide (double barrier methods)

• Fully healed criteria: no bleeding, no oozing, no broken skin, no obvious sign of infection, such as swelling or redness, around the scar.

Exclusion criteria

• lacking Mental Capacity to give Informed Consent
• women who self-declare that they are pregnant, or that they will be trying to become pregnant, during the treatment phase of the Trial*
• impaired sensation as measured by hot/ cold test and sharp/ blunt test
• unable to read and speak English - the questionnaires being used have not been translated and validated in multiple languages and no facility is available to conduct nor translate/ back-translate semi-structured interview data
• epileptic
• active deep vein thrombosis, thrombophlebitis, or varicose veins
• fitted with a pacemaker
• has a metal implant in the area to be stimulated
• any residual limb complications such as cellulitis, wounds, infections etc.
• Active regions of known or suspected malignancy
• Any actively bleeding tissue or to persons with untreated haemorrhagic disorders
• Participating in any research trial of any intervention hypothesised to affect PLP
• Any current or recent history of substance misuse, alcohol, or drug dependency
• Any person, otherwise eligible, who commences any non-pharmacological treatment for PLP during the trial period