Dextromethorphan for phantom pain attenuation in cancer amputees: a double-blind crossover trial involving three patients.
BACKGROUND
Phantom limb pain is an intriguing pain syndrome that may result from damage to peripheral nerve tissue but could also involve central amplifying congeners. N-methyl-D-aspartate (NMDA)-receptor antagonists were recently shown to alleviate neuropathic pain in both animal and human models. Dextromethorphan is a noncompetitive NMDA-receptor antagonist.


METHODS
Oral dextromethorphan (120-180 mg daily) was administered to three selected cancer patients during a 3-week study and an additional 1 month of treatment with the dosage subjectively judged to be best.


RESULTS
Oral dextromethorphan effectively reduced postamputation phantom limb pain, bestowing improvement in feeling and minimizing sedation in comparison with the pretreatment or placebo conditions, with no side effects. Pain recurred in one patient 1 month after treatment was stopped.


CONCLUSIONS
Further clinical trials are warranted to determine the optimal dosage and identify which patients with phantom pain would benefit the most from this therapeutic approach.
Ben Abraham
Ron
R
Post Anesthesia Care Unit, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Marouani
Nissim
N
Kollender
Yehuda
Y
Meller
Isaac
I
Weinbroum
Avi A
AA
D000284:Administration, Oral; D000328:Adult; D000671:Amputation, Surgical / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D018592:Cross-Over Studies; D003915:Dextromethorphan / Q000008:administration & dosage*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery; D010147:Pain Measurement / Q000379:methods; D010591:Phantom Limb / Q000145:classification / Q000188:drug therapy* / Q000209:etiology; D012008:Recurrence; D012647:Self-Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D003915:Dextromethorphan