Improving the lives of people with Phantom Limb Pain - the TITAN trial (graded moTor Imagery for phanTom lImb pAiN)

Phantom Limb Pain is a rare pain condition. It is one of the most distressing and disabling of all pain conditions. It is characterised by a very severe burning, stinging and/or stabbing pain, described as “terrifying”. Up to 75% of people with Phantom Limb Pain report suicidal thoughts. No treatments are supported by high quality evidence. Clinicians and patients are left with trial and error combined with anecdote to guide management.

We have identified and pilot tested the most promising intervention for Phantom Limb Pain - Graded Motor Imagery. We are now ready to test the efficacy of this intervention in a randomised, double-blind, sham- controlled, clinical trial to comprehensively determine whether this highly promising intervention improves outcomes for patients with Phantom Limb Pain. We will identify potential participants from our neuropathic pain Clinical Networks in Australia. We will randomise 170 participants with Phantom Limb Pain into 2 groups using 1:1 ratio: Graded Motor Imagery (n=85), sham graded motor imagery(n=85). The duration of the interventions is 6 weeks. The primary outcome will be mean pain intensity over the past week, measured by an 11-point Numerical Rating Scale at 3 months post intervention. Secondary outcomes include disability (Patient Specific Functional Scale (PSFS) assessed at 6/52, 12/52, 26/52 and 1 year.