Practical experience with sonographically guided phenol instillation of stump neuroma: predictors of effects, success, and outcome.
OBJECTIVE
Phantom limb pain and stump pain frequently occur after limb amputation, and stump neuromas play an important role in generation of the pain. The purpose of this study was to evaluate the effects of a previously described optimized procedure for sclerosis of painful stump neuromas under real-time high-resolution sonographic guidance.


METHODS
In this prospective study, neurosclerosis was performed on 82 patients by means of high-resolution sonographically guided injection of up to 0.8 mL of 80% phenol solution according to a standardized protocol.


RESULTS
During treatment all patients had marked improvement in terms of reduction of pain measured with a visual analog scale. Twelve (15%) of the subjects were pain free after one to three treatments, nine of the 12 achieving relief with the initial instillation. At 6-month follow-up evaluation, 52 patients assessed their present pain quantity with a simplified three-step score. Twenty (38%) of the 52 patients reported almost unnoticeable pain, and 33 (64%) reported pain equal to the minimum reached during therapy. In 18 (35%) of the 52 patients, the incidence of painful periods had markedly decreased. The neurosclerosis procedure had a low complication rate (5% rate of minor complications, 1.3% rate of major complications).


CONCLUSIONS
The high-resolution sonographically guided neurosclerosis procedure had a significantly better outcome than other documented treatments. Sonographically guided neurosclerosis should be included in the management of chronic phantom limb and stump pain.
Gruber
Hannes
H
Department of Radiology, Radiodiagnostics Clinic, Department I, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. hannes.gruber@i-med.ac.at
Glodny
Bernhard
B
Bodner
Gerd
G
Kopf
Helmut
H
Bendix
Nadine
N
Galiano
Klaus
K
Strasak
Alexander
A
Peer
Siegfried
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004360:Drug Therapy, Computer-Assisted; D005260:Female; D006801:Humans; D007322:Instillation, Drug; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D009463:Neuroma / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D010524:Peripheral Nervous System Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D010591:Phantom Limb / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D019800:Phenol / Q000008:administration & dosage*; D011446:Prospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D015911:Sclerotherapy / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography
D012597:Sclerosing Solutions; D019800:Phenol