Treating intractable phantom limb pain with ambulatory continuous peripheral nerve blocks: A pilot study

Brian M. Ilfeld, Tobias Moeller-Bertram, Steven R. Hanling, Kyle Tokarz, Edward R. Mariano, Vanessa J. Loland, Sarah J. Madison, Eliza J. Ferguson, Anya C. Morgan, Mark S. Wallace

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)935-942
Number of pages8
JournalPain Medicine (United States)
Volume14
Issue number6
DOIs
StatePublished - Jun 2013

Fingerprint

Phantom Limb
Intractable Pain
Nerve Block
Peripheral Nerves
Catheters
Pain
Infusion Pumps
Lost to Follow-Up
Therapeutics
Elbow
Thigh
Amputation
Chronic Pain
Knee
Outpatients
Randomized Controlled Trials

Keywords

  • Chronic pain
  • Persistent pain
  • Persistent post-surgical pain
  • Persistent postsurgical pain

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Ilfeld, B. M., Moeller-Bertram, T., Hanling, S. R., Tokarz, K., Mariano, E. R., Loland, V. J., ... Wallace, M. S. (2013). Treating intractable phantom limb pain with ambulatory continuous peripheral nerve blocks: A pilot study. Pain Medicine (United States), 14(6), 935-942. https://doi.org/10.1111/pme.12080

Treating intractable phantom limb pain with ambulatory continuous peripheral nerve blocks : A pilot study. / Ilfeld, Brian M.; Moeller-Bertram, Tobias; Hanling, Steven R.; Tokarz, Kyle; Mariano, Edward R.; Loland, Vanessa J.; Madison, Sarah J.; Ferguson, Eliza J.; Morgan, Anya C.; Wallace, Mark S.

In: Pain Medicine (United States), Vol. 14, No. 6, 06.2013, p. 935-942.

Research output: Contribution to journalArticle

Ilfeld, BM, Moeller-Bertram, T, Hanling, SR, Tokarz, K, Mariano, ER, Loland, VJ, Madison, SJ, Ferguson, EJ, Morgan, AC & Wallace, MS 2013, 'Treating intractable phantom limb pain with ambulatory continuous peripheral nerve blocks: A pilot study', Pain Medicine (United States), vol. 14, no. 6, pp. 935-942. https://doi.org/10.1111/pme.12080
Ilfeld, Brian M. ; Moeller-Bertram, Tobias ; Hanling, Steven R. ; Tokarz, Kyle ; Mariano, Edward R. ; Loland, Vanessa J. ; Madison, Sarah J. ; Ferguson, Eliza J. ; Morgan, Anya C. ; Wallace, Mark S. / Treating intractable phantom limb pain with ambulatory continuous peripheral nerve blocks : A pilot study. In: Pain Medicine (United States). 2013 ; Vol. 14, No. 6. pp. 935-942.
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T1 - Treating intractable phantom limb pain with ambulatory continuous peripheral nerve blocks

T2 - A pilot study

AU - Ilfeld, Brian M.

AU - Moeller-Bertram, Tobias

AU - Hanling, Steven R.

AU - Tokarz, Kyle

AU - Mariano, Edward R.

AU - Loland, Vanessa J.

AU - Madison, Sarah J.

AU - Ferguson, Eliza J.

AU - Morgan, Anya C.

AU - Wallace, Mark S.

PY - 2013/6

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N2 - 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.

AB - 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.

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KW - Persistent pain

KW - Persistent post-surgical pain

KW - Persistent postsurgical pain

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