Dawaa Reference

acute

Phantom Limb Pain

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources6 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 against5 documents
  • 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 date2026-08

Presentation reference

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

SourceStatPearls "Phantom Limb Pain" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Tricyclic antidepressant - neuropathic pain | Simple analgesia

MAIN TREATMENT

1

GABAPENTIN

1st line

Formoral.solid

Adult dose and duration

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.

Paediatric dose

The formulary's paediatric gabapentin dosing is for epilepsy with partial-onset seizures, not for pain, and is not reproduced here.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
GABA 100MG 10 CAPS.MULTI-APEX > MULTIPHARMA6.50 EGP (0.65/unit)
PENTALIPSY 100 MG 10 CAPS.SAFE PHARMA8.00 EGP (0.80/unit)
EZAPENTIN 300MG 10 CAPS.MULTI-APEX11.00 EGP (1.10/unit)
GABAPENTIN 300 MG 30 CAPS.UNIPHARMA96.00 EGP (3.20/unit)
ANDOPENTENE XR 300 MG 20 F.C. TABS.ANDALOUS PHARMA90.00 EGP (4.50/unit)
CONVENTIN 600 MG 30 TABS.EVA PHARMA171.00 EGP (5.70/unit)
GABAVERONA 400 MG 30 H.G. CAPS.AVERROES PHARMA156.00 EGP
SAJALIPSY 400 MG 30 H.G. CAPS.SAJA PHARMACEUTICALS156.00 EGP
STABLENTIN 6MG/120ML SYRUP? strength differs? different route - not oral solidMEPACO21.60 EGP
ADAPTAN 250MG/5ML ORAL SOLUTION 100 ML? strength differs? different route - not oral solidEUROPEAN EGYPTIAN PHARM. IND.37.00 EGP

TRICYCLIC ANTIDEPRESSANT - NEUROPATHIC PAIN

2

AMITRIPTYLINE

Tricyclic antidepressant - neuropathic pain

1st line

Strength25 mg

Formoral.solid

Adult dose and duration

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

Paediatric dose

The MSF amitriptyline monograph gives no paediatric dose, so none is stated here.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
TRYPTIZOL 25 MG 30 TABS.KAHIRA33.00 EGP (1.10/unit)
GRANITYLLIN 25MG/5ML SYP. 120 ML? strength differs? different route - not oral solidGRAND PHARMA > DELTA GRAND PHARMA5.00 EGP
ZINOTRAVAL 25MG/5ML SYP. 120 ML? strength differs? different route - not oral solidDEBEIKY > PHARMACHEMIC10.00 EGP

SIMPLE ANALGESIA - give alongside

3

PARACETAMOL

Simple analgesia

add-on - not a substitute

Strength500 mg

Formoral.solid

Adult dose and duration

1 g 3 or 4 times daily (maximum 4 g daily)

Paediatric dose

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).)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 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.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP
4

IBUPROFEN

Simple analgesia

add-on - not a substitute

Strength400 mg

Formoral.solid

Adult dose and duration

200 to 400 mg 3 to 4 times daily (maximum 1,200 mg daily)

Paediatric dose

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).)

Dose by weight
3kg15-30 mg/dose
4kg20-40 mg/dose
5kg25-50 mg/dose
6kg30-60 mg/dose
7kg35-70 mg/dose
8kg40-80 mg/dose
9kg45-90 mg/dose
10kg50-100 mg/dose
11kg55-110 mg/dose
12kg60-120 mg/dose
13kg65-130 mg/dose
14kg70-140 mg/dose
15kg75-150 mg/dose
16kg80-160 mg/dose
17kg85-170 mg/dose
18kg90-180 mg/dose
19kg95-190 mg/dose
20kg100-200 mg/dose
21kg105-210 mg/dose
22kg110-220 mg/dose
23kg115-230 mg/dose
24kg120-240 mg/dose
25kg125-250 mg/dose
26kg130-260 mg/dose
27kg135-270 mg/dose
28kg140-280 mg/dose
29kg145-290 mg/dose
30kg150-300 mg/dose
31kg155-310 mg/dose
32kg160-320 mg/dose
33kg165-330 mg/dose
34kg170-340 mg/dose
35kg175-350 mg/dose
36kg180-360 mg/dose
37kg185-370 mg/dose
38kg190-380 mg/dose
39kg195-390 mg/dose
40kg200-400 mg/dose
41kg205-400 mg/dose (upper capped)
42kg210-400 mg/dose (upper capped)
43kg215-400 mg/dose (upper capped)
44kg220-400 mg/dose (upper capped)
45kg225-400 mg/dose (upper capped)
46kg230-400 mg/dose (upper capped)
47kg235-400 mg/dose (upper capped)
48kg240-400 mg/dose (upper capped)
49kg245-400 mg/dose (upper capped)
50kg250-400 mg/dose (upper capped)
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.