Post-amputation phantom pain and autonomous stump movements responsive to doxepin.

A 40-year old man with post-amputation phantom pain and involuntary autonomous movements experienced dramatic relief of both pain and autonomous movements with administration of the antidepressant doxepin. The pathophysiology of pain and post-amputation autonomous movements, as well as the therapeutic response to doxepin are discussed in terms of the effects of limb amputation on spinal excitability and alterations in both spinal and supraspinal transmitter functions.