# Phantom Limb Pain - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - nervous-2025.pdf, Gabapentin monograph (chapter PDF p68) · Egyptian National Drug Formulary 2025 — Nervous System Disorders, Gabapentin monograph, Peripheral Neuropathic Pain in adults (nervous-2025.pdf, page index 67, printed p57) · Hanyu-Deutmeyer AA, Cascella M, Varacallo MA. Phantom Limb Pain. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2023 Aug 4. Bookshelf ID: NBK448188; PMID: 28846343. · MSF Essential Drugs 2024 (paracetamol oral monograph) · MSF Essential Drugs 2024 (ibuprofen oral monograph) · MSF Essential Drugs 2024 (amitriptyline oral monograph, neuropathic pain indication) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary 2025 — Nervous System Disorders, Gabapentin monograph, Peripheral Neuropathic Pain in adults (nervous-2025.pdf, page index 67, printed p57) - Hanyu-Deutmeyer AA, Cascella M, Varacallo MA. Phantom Limb Pain. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2023 Aug 4. Bookshelf ID: NBK448188; PMID: 28846343. - MSF Essential Drugs 2024 (paracetamol oral monograph) - MSF Essential Drugs 2024 (ibuprofen oral monograph) - MSF Essential Drugs 2024 (amitriptyline oral monograph, neuropathic pain indication) ## Treatment metadata - Gabapentin — oral.solid - Amitriptyline — 25 mg — oral.solid - Paracetamol — 500 mg — oral.solid - Ibuprofen — 400 mg — oral.solid ## Complete treatment card ```text PHANTOM LIMB PAIN Sources: Egyptian National Drug Formulary - nervous-2025.pdf, Gabapentin monograph (chapter PDF p68) · Egyptian National Drug Formulary 2025 — Nervous System Disorders, Gabapentin monograph, Peripheral Neuropathic Pain in adults (nervous-2025.pdf, page index 67, printed p57) · Hanyu-Deutmeyer AA, Cascella M, Varacallo MA. Phantom Limb Pain. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2023 Aug 4. Bookshelf ID: NBK448188; PMID: 28846343. · MSF Essential Drugs 2024 (paracetamol oral monograph) · MSF Essential Drugs 2024 (ibuprofen oral monograph) · MSF Essential Drugs 2024 (amitriptyline oral monograph, neuropathic pain indication) Review status: REVIEWED against 5 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Tingling, throbbing, sharp, or pins-and-needles sensations in the missing limb are typical, more often after an arm than a leg amputation [tingling] - It is pain or discomfort felt in a limb that is no longer there [phantom pain] - Almost every amputee has pain of some kind: 95% overall, 80% phantom pain, 68% pain in the stump [phantom pain] - The amputation itself may have been for severe trauma, a tumour, vascular disease or infection SIGNS - what you find (2) - Residual limb pain itself tends to be milder and feels pressing, burning, squeezing, or stabbing, unlike phantom pain [phantom pain] - Exam looks for wound infection, allodynia or hyperalgesia, and dysfunction of the joint just above the amputation [hyperalgesia] TESTS (1) - Diagnosis relies mainly on history as a diagnosis of exclusion, but a CBC can rule out infection and ultrasound can look for a neuroma IF NOT THIS - what else fits (5) - Septic arthritis, osteomyelitis, a retained foreign body reaction, neuroma, or arthritis in the residual limb are considered on the differential - Residual limb pain is the other kind, arising from the amputation site itself - That one comes early after surgery and usually goes as the wound heals - And unlike phantom pain it usually has a findable cause: a trapped nerve, a neuroma, surgical trauma, poor blood supply, broken skin or infection - More than half of those with phantom pain have the stump kind as well, so finding one does not exclude the other Source StatPearls "Phantom Limb Pain" - disease-level clinical article Status traced to the source above Rx: Main treatment | Tricyclic antidepressant - neuropathic pain | Simple analgesia MAIN TREATMENT 1. GABAPENTIN [1st line] Adult Peripheral neuropathic pain, immediate-release: Day 1, 300 mg orally once; Day 2, 300 mg twice daily; Day 3, 300 mg three times daily; then increase in 300 mg/day steps every 2-3 days as needed, up to 1800 mg/day in three divided doses. - As directed; the minimum time to reach 1800 mg/day is one week. Reassess response before increasing further or referring, and stop gradually over at least 1 week. Peds The formulary's paediatric gabapentin dosing is for epilepsy with partial-onset seizures, not for pain, and is not reproduced here. Source Egyptian National Drug Formulary 2025 — Nervous System Disorders, Gabapentin monograph, Peripheral Neuropathic Pain in adults (nervous-2025.pdf, page index 67, printed p57) Why Gabapentin is a standard first-line neuropathic agent for phantom limb pain, dosed and titrated as for other peripheral neuropathic pain syndromes. Caution Discontinue gradually over a minimum of 1 week, whatever the indication. Reduce the dose in renal impairment: total daily dose 400 to 1400 mg divided twice daily at CrCl 30-59 mL/min, and 200 to 700 mg once daily at CrCl 15-29 mL/min. Do not leave more than 12 hours between doses; the total daily dose is divided into three. The formulary gives this dose for peripheral neuropathic pain in adults (painful diabetic neuropathy, post-herpetic neuralgia). It carries no dose for phantom limb pain — using it there is extrapolation, not formulary guidance. Sedation and dizziness are common, especially at initiation - caution with driving or operating machinery. Reduce dose in renal impairment. Taper gradually if stopping - do not withdraw abruptly, over a minimum of 1 week. Check the stump/wound for infection in a recent amputee before attributing pain to phantom limb syndrome. Refer to pain management or rehabilitation if pain does not respond to standard titration. Egypt GABA 100MG 10 CAPS. MULTI-APEX > ... 6.50 EGP (0.65/unit) PENTALIPSY 100 MG 10 CAPS. SAFE PHARMA 8.00 EGP (0.80/unit) EZAPENTIN 300MG 10 CAPS. MULTI-APEX 11.00 EGP (1.10/unit) GABAPENTIN 300 MG 30 CAPS. UNIPHARMA 96.00 EGP (3.20/unit) ANDOPENTENE XR 300 MG 20 F.C. TABS. ANDALOUS PHARMA 90.00 EGP (4.50/unit) CONVENTIN 600 MG 30 TABS. EVA PHARMA 171.00 EGP (5.70/unit) GABAVERONA 400 MG 30 H.G. CAPS. AVERROES PHARMA 156.00 EGP SAJALIPSY 400 MG 30 H.G. CAPS. SAJA PHARMACE... 156.00 EGP STABLENTIN 6MG/120ML SYRUP MEPACO 21.60 EGP -> ? strength differs, ? different route - not oral solid ADAPTAN 250MG/5ML ORAL SOLUTION 100 ML EUROPEAN EGYPTIAN PHARM. IND. 37.00 EGP -> ? strength differs, ? different route - not oral solid TRICYCLIC ANTIDEPRESSANT - NEUROPATHIC PAIN 2. AMITRIPTYLINE [1st line] Adult 25 mg once daily at bedtime (week 1); 50 mg once daily at bedtime (week 2); 75 mg once daily at bedtime from week 3 (do not exceed 150 mg daily) x 3 to 6 months after pain relief is obtained Peds The MSF amitriptyline monograph gives no paediatric dose, so none is stated here. Source MSF Essential Drugs 2024 (amitriptyline oral monograph, neuropathic pain indication) Why Phantom limb pain is neuropathic pain, which is an explicit MSF indication for amitriptyline; the disease article names amitriptyline as the tricyclic of choice. MSF adds that for neuropathic pain amitriptyline is often given in combination with gabapentin, which is the card's existing drug. Caution Do not administer to patients with recent myocardial infarction, arrhythmia, closed- angle glaucoma, or prostate disorders. Reduce the dose by half in older patients, and in renal or hepatic impairment. Administer with caution and monitor carefully in epilepsy, chronic constipation, history of bipolar disorder, and suicidal ideation. The analgesic effect is delayed for 7 to 10 days - warn the patient before starting. Do not exceed 150 mg daily. Avoid in elderly patients, and in severe cardiovascular disease or arrhythmias. Amitriptyline - StatPearls - NCBI Bookshelf (NBK537225) puts amitriptyline on the American Geriatrics Society's Beers list, to be avoided in the elderly because its anticholinergic effect is so strong. Egypt TRYPTIZOL 25 MG 30 TABS. KAHIRA 33.00 EGP (1.10/unit) GRANITYLLIN 25MG/5ML SYP. 120 ML GRAND PHARMA ... 5.00 EGP -> ? strength differs, ? different route - not oral solid ZINOTRAVAL 25MG/5ML SYP. 120 ML DEBEIKY > PHA... 10.00 EGP -> ? strength differs, ? different route - not oral solid SIMPLE ANALGESIA - give alongside 3. PARACETAMOL [add-on - not a substitute] Adult 1 g 3 or 4 times daily (maximum 4 g daily) Peds 15 mg/kg/dose [child max 500 mg] (MSF: child under 1 month, 10 mg/kg 3 or 4 times daily (max. 40 mg/kg daily); child 1 month and over, 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily).) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Choice Alternatives. The disease article offers acetaminophen or an NSAID for this pain, without ranking them. Paracetamol is named first choice because MSF contraindicates ibuprofen in peptic ulcer, asthma, renal impairment and dehydration, while paracetamol's only stated caution is hepatic impairment - so it is the safer default when the prescriber has not assessed those. Ibuprofen stays on the card. Source MSF Essential Drugs 2024 (paracetamol oral monograph) Why The disease article describes NSAIDs and acetaminophen as the most commonly used pharmacologic treatment for phantom limb pain; the card offered only gabapentin. Caution Administer with caution to patients with hepatic impairment. Do not exceed indicated doses, especially in children and older patients - paracetamol intoxications are severe (hepatic cytolysis). Reduce the dose in children with severe acute malnutrition: 10 mg/kg up to 3 times maximum per 24 hours. Paracetamol has no anti-inflammatory properties. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 4. IBUPROFEN [add-on - not a substitute] Adult 200 to 400 mg 3 to 4 times daily (maximum 1,200 mg daily) Peds 5-10 mg/kg/dose [child max 400 mg] (MSF: child over 3 months, 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily).) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) Source MSF Essential Drugs 2024 (ibuprofen oral monograph) Why Named with acetaminophen by the disease article as the most commonly used pharmacologic treatment for phantom limb pain. Caution Do not administer to children under 3 months, patients with allergy to NSAID, peptic ulcer, coagulation defects, haemorrhage, surgery with risk of major blood loss, severe renal or hepatic impairment, severe heart failure, severe malnutrition, uncorrected dehydration or hypovolaemia, severe infection. Administer with caution to elderly or asthmatic patients. Do not combine with methotrexate, anticoagulants and other NSAIDs. Avoid in pregnancy; ibuprofen is contraindicated from the beginning of the 6th month - use paracetamol. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)