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 language | English (US) |
|---|---|
| Pages (from-to) | 935-942 |
| Number of pages | 8 |
| Journal | Pain Medicine (United States) |
| Volume | 14 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 2013 |
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Keywords
- Chronic pain
- Persistent pain
- Persistent post-surgical pain
- Persistent postsurgical pain
ASJC Scopus subject areas
- Clinical Neurology
- Anesthesiology and Pain Medicine
Cite this
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 journal › Article
}
TY - JOUR
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
Y1 - 2013/6
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.
KW - Chronic pain
KW - Persistent pain
KW - Persistent post-surgical pain
KW - Persistent postsurgical pain
UR - http://www.scopus.com/inward/record.url?scp=84879499102&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84879499102&partnerID=8YFLogxK
U2 - 10.1111/pme.12080
DO - 10.1111/pme.12080
M3 - Article
C2 - 23489466
AN - SCOPUS:84879499102
VL - 14
SP - 935
EP - 942
JO - Pain Medicine
JF - Pain Medicine
SN - 1526-2375
IS - 6
ER -