Table 1

Levels of evidence for treatment and prevention of postamputation pain6 13 46 48 59 61 102

Type of postamputation pain	Level I	Level II	Level III	Level IV	Negative
Treatment of phantom limb pain	(None)	Gabapentin Transcranial direct current stimulation (short-term benefit)	Tricyclic antidepressants NMDA receptor antagonists (ketamine and dextromethorphan) for short-term benefit Peripheral nerve stimulation Prolonged local anesthetic infusion Targeted muscle reinnervation surgery Opioids	Calcitonin Repetitive transcranial magnetic stimulation (short-term benefit) Mirror therapy and virtual reality (short-term benefit) Regenerative peripheral nerve interface surgery Neurolysis of painful neuroma	Intravenous lidocaine Botulinum toxin Sympathetic blocks (provide only immediate-term relief)
Treatment of residual limb pain	(None)		Intravenous lidocaine (immediate-term benefit) Prolonged local anesthetic infusion Targeted muscle reinnervation surgery	Regenerative peripheral nerve interface surgery Neurolysis of painful neuroma	Botulinum toxin Sympathetic blocks (provide only immediate-term relief)
Prevention of postamputation pain	(None)		Targeted muscle reinnervation surgery Patient-controlled opioid analgesia	Epidural anesthesia placed >24 hours before surgery (including with calcitonin) Catheter-based regional anesthesia Regenerative peripheral nerve interface surgery Ketamine infusion	Gabapentin Stump wrapping/limb cover (eg, aluminum foil)

Levels of evidence based on modified Oxford Centre for Evidence-based Medicine Levels of Evidence criteria.6 103 I=systematic review of randomized trials or n-of-1 trials, II=randomized trial(s) or observational study(ies) with dramatic effect, III=non-randomized controlled cohort/follow-up study(ies), IV=case-series, case–control studies, or historically controlled studies. Note that levels may be downgraded on the basis of study quality, imprecision, indirectness, inconsistency between studies, or small absolute effect sizes.