Treatment of phantom limb pain with botulinum toxin type A

Abstract

Introduction: Phantom limb pain and sensations are common in amputees. The pathophysiology remains unclear and the treatment difficult and often unsuccessful. Opioids are frequently used when non-narcotics have failed, but are not effective in many cases. We report on three phantom and stump pain patients, refractive to previous treatments, who were successfully treated with botulinum toxin A (BoNT-A).

Methods: Three patients who had previously undergone amputation of their leg due to accident (N = 2) or injury by a landmine (N = 1) were treated with BoNT-A (Dysport). We injected a total dose of up to 500 units (U) BoNT-A under EMG-control. Global clinical improvement was based on a 0-3 scale (0 = no effect; 3 = marked improvement) and on a questionnaire rating pain intensity (based on the visual analog scale), intake of pain medication and phantom limb sensations.

Results: All three patients evaluated the clinical global improvement with 3 (marked improvement). The pain intensity and pain medication was reduced significantly in all three cases. No side effects were reported. The duration of response lasted up to 11 weeks.

Discussion: These three successfully treated phantom and stump pain patients show that therapy with BoNT-A may be worth studying as an effective and safe treatment option for this kind of pain.