title: Treatment of phantom limb pain with botulinum toxin type A.
abstract: BACKGROUND
  Phantom limb pain and sensations are common in amputees. The pathophysiology remains unclear and the treatment difficult and often unsuccessful. Opioids are frequently used when non-narcotics have failed, but are not effective in many cases. We report on three phantom and stump pain patients, refractive to previous treatments, who were successfully treated with botulinum toxin A (BoNT-A).
  
  
  METHODS
  Three patients who had previously undergone amputation of their leg due to accident (N = 2) or injury by a landmine (N = 1) were treated with BoNT-A (Dysport). We injected a total dose of up to 500 units (U) BoNT-A under EMG-control. Global clinical improvement was based on a 0-3 scale (0 = no effect; 3 = marked improvement) and on a questionnaire rating pain intensity (based on the visual analog scale), intake of pain medication and phantom limb sensations.
  
  
  RESULTS
  All three patients evaluated the clinical global improvement with 3 (marked improvement). The pain intensity and pain medication was reduced significantly in all three cases. No side effects were reported. The duration of response lasted up to 11 weeks.
  
  
  CONCLUSIONS
  These three successfully treated phantom and stump pain patients show that therapy with BoNT-A may be worth studying as an effective and safe treatment option for this kind of pain.
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Medical School of Hannover, Hannover, Germany.
authors.forename: Lingjing
authors.initials: L
authors.lastname: Jin
authors.forename: Katja
authors.initials: K
authors.lastname: Kollewe
authors.forename: Klaus
authors.initials: K
authors.lastname: Krampfl
authors.forename: Reinhard
authors.initials: R
authors.lastname: Dengler
authors.forename: Bahram
authors.initials: B
authors.lastname: Mohammadi
mesh_terms: D000328:Adult; D000674:Amputees; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy; D010591:Phantom Limb / Q000188:drug therapy*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A