Treatment of phantom pain with contralateral injection into tender points: a new method of treatment

Alaa A El Aziz Labeeb,Roberto Casale

doi:10.4103/1110-161x.163929

Abstract

The aim of this study was to ascertain the existence of contralateral painful muscle areas mirroring phantom pain and to evaluate the short-term effects of anaesthetics versus saline, injected contralaterally to control phantom and phantom limb pain. This was a double-blinded cross-over study. This study included eight lower-limb amputees with phantom limb pain in the past 6 months. Either 1 ml of 0.25% bupivacaine or 0.9% saline was injected alternately in each point with a 28-G needle, with 72 h between injections. The main outcomes measured were phantom sensation modification and the intensity of phantom limb pain (visual analogue scale) before and after injections. Painful muscle areas in the healthy limb do not mirror the topographical distribution of phantom limb pain. At 60 min after the injection, a statistically significantly greater relief of phantom limb pain was observed after using a local anaesthetic compared with that when using saline injection (P = 0.003). Bupivacaine consistently reduced/abolished the phantom sensation in six out of eight patients. These effects on phantom sensation were not observed after saline injections. Contralateral injections of 1 ml of 0.25% bupivacaine in the myofascial hyperalgesic areas attenuated phantom limb pain and affected phantom limb sensation. Our study gives a basis of a new method of management of that kind of severe pain to improve the method of rehabilitation of amputee. However, further longitudinal studies with larger number of patients are needed to confirm our study.

Highlights

Phantom limb pain has been reported to occur in up to 90% of limb amputees [1]
No statistically significant differences were found on comparing the basal values of phantom pain before treatments
No statistically significant difference was found in phantom pain values in the two groups between the first and the second treatment (Table 2 and Fig. 2)

Summary

Introduction

Phantom limb pain has been reported to occur in up to 90% of limb amputees [1]. Despite such a high prevalence of this problem and a wide variety of treatment approaches that have been used, mechanism-based specific treatment guidelines are yet to evolve [2,3]. The nonpharmacological or local modalities used for treating phantom pain range from invasive procedures such as spinal surgery [4,5] to less invasive treatments such as electrotherapy [6], acupuncture [7] and the use of local anaesthetics [8]. Acupuncture needs to engage the nervous system to override the response to mismatched information. Acupuncture stimulation of points in the ear, stump, scalp and contralateral limb has been reported to help alleviate symptoms in individuals with phantom limb syndrome [9,10,11]

Results

Discussion

Conclusion