Open AccessTreating Intractable Phantom Limb Pain with Ambulatory Continuous Peripheral Nerve Blocks: A Pilot Study
Author(s) -
Ilfeld Brian M.,
MoellerBertram Tobias,
Hanling Steven R.,
Tokarz Kyle,
Mariano Edward R.,
Loland Vanessa J.,
Madison Sarah J.,
Ferguson Eliza J.,
Morgan Anya C.,
Wallace Mark S.
Publication year - 2013
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12080
Subject(s) - medicine , peripheral , ambulatory , phantom limb pain , peripheral nerve , phantom limb , anesthesia , chronic pain , physical medicine and rehabilitation , imaging phantom , physical therapy , surgery , radiology , anatomy , amputation
Background. There is currently no reliable treatment for phantom limb pain ( PLP ). Chronic PLP and associated cortical abnormalities may be maintained from abnormal peripheral input, raising the possibility that a continuous peripheral nerve block ( CPNB ) of extended duration may permanently reorganize cortical pain mapping, thus providing lasting relief. Methods. Three men with below‐the‐knee (2) or ‐elbow (1) amputations and intractable PLP received femoral/sciatic or infraclavicular perineural catheter(s), respectively. Subjects were randomized in a double‐masked fashion to receive perineural ropivacaine (0.5%) or normal saline for over 6 days as outpatients using portable electronic infusion pumps. Four months later, subjects returned for repeated perineural catheter insertion and received an ambulatory infusion with the alternate solution (“crossover”). Subjects were followed for up to 1 year. Results. By chance, all three subjects received saline during their initial infusion and reported little change in their PLP . One subject did not receive crossover treatment, but the remaining two subjects reported complete resolution of their PLP during and immediately following treatment with ropivacaine. One subject experienced no PLP recurrence through the 52‐week follow‐up period and the other reported mild PLP occurring once each week of just a small fraction of his original pain (pretreatment: continuous PLP rated 10/10; posttreatment: no PLP at baseline with average of one PLP episode each week rated 2/10) for 12 weeks (lost to follow‐up thereafter). Conclusions. A prolonged ambulatory CPNB may be a reliable treatment for intractable PLP . The results of this pilot study suggest that a large, randomized clinical trial is warranted.