Phantom limb pain can turn a traumatic experience into a lifetime of chronic pain, as mentioned in the interesting and well-written "Accidental Amputation" (Emergency, February). However, preliminary evidence shows that sustained multimodal pain management both before and after surgical amputation may decrease the incidence and severity of phantom limb pain. 1-3 Promising treatments include the use of such agents as N-methyl-D-aspartate receptor antagonists and anticonvulsants.

The most important thing is to ensure adequate pain management, preferably soon after the injury occurs. If a patient has lived with a mangled limb for a year before surgical amputation, alleviating postsurgical phantom limb pain is more difficult, especially if pain had not been attended to immediately after injury.

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