Phantom limb sensation and its treatment with botulinum toxin type A

Introduction: Phantom limb pain and sensations are common in amputees. Its definite pathophysiology remains still unclear and therefore the treatment is very difficult and in some cases insufficient. Opioids are often used when non-narcotics have failed, but are also often not effective. We report about three successful treated phantom and stump pain patients with botulinum toxin type A (BTX A, Dysport®)

Methods: Three patients who had previously undergone amputation of their leg due to an accident (n=2) and an injury by a landmine (n=1) were treated with BTX type A (Dysport®). We injected a total dose of up to 500MU BTX type A (Dysport®) under EMG-control in the muscles of the stump. The response rate was based on a 0–3 scale (0=no effect; 3=marked improvement) and on a questionnaire including pain intensity (based on the Visual Analogue Scale, VAS), intake of pain medication and phantom limb sensations.

Results: All three patients evaluated the clinical global improvement with 3 (“marked improvement“). The intensity, frequency and duration of the pain could be reduced significantly and therefore the pain medication could be lowered radically in all three cases. All patients experienced a reduction of phantom limb sensations. No side-effects were reported. The duration of response lasted up to 12 weeks.

Discussion: The three successful treated phantom and stump pain patients facilitate this therapeutic approach and support the conclusion that the therapy with BTX type A (Dysport®) is a very effective and safe treatment for this kind of pain.