title: [Long-term treatment of phantom- and stump pain with Botulinum toxin type A over 12 months. A first clinical observation].
abstract: Recently we were able to describe the successful treatment of phantom pain and stump pain with botulinum toxin A in a first pilot study. This case report over a 1-year period now demonstrates that long-term treatment for this indication is possible. We injected 4 x 25 IU of botulinum toxin A (Botox) into trigger points of the stump muscles of a lower limb amputee who suffered from severe phantom and stump pain. With four injections performed every 3 months, the patient became almost completely pain-free, and his intrathecal morphine therapy could be reduced to 40% of the initial dose. Intrathecal clonidine was eliminated completely, as were the oral analgesics. A surgical treatment suggested for the stump pain was no longer necessary, and we suppose that botulinum toxin can also improve the tolerance of artificial limbs in cases of stump pain.
authors.affiliation: Schmerztherapie/Fachbereich für Neurologie, Deutsche Klinik für Diagnostik, Wiesbaden. kern.neuro@dkd-wiesbaden.de
authors.forename: U
authors.initials: U
authors.lastname: Kern
authors.forename: C
authors.initials: C
authors.lastname: Martin
authors.forename: S
authors.initials: S
authors.lastname: Scheicher
authors.forename: H
authors.initials: H
authors.lastname: Müller
mesh_terms: D000671:Amputation, Surgical / Q000009:adverse effects*; D000672:Amputation Stumps; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003000:Clonidine / Q000627:therapeutic use; D006801:Humans; D007273:Injections, Intramuscular; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009209:Myofascial Pain Syndromes / Q000188:drug therapy* / Q000209:etiology; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010591:Phantom Limb / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D009020:Morphine; D019274:Botulinum Toxins, Type A; D003000:Clonidine