TY - JOUR
T1 - The role of afferent input in postamputation pain
T2 - a randomized, double-blind, placebo-controlled crossover study
AU - Buch, Nina Stockfleth
AU - Ahlburg, Peter
AU - Haroutounian, Simon
AU - Andersen, Niels Trolle
AU - Finnerup, Nanna Brix
AU - Nikolajsen, Lone
PY - 2019/7
Y1 - 2019/7
N2 - In this randomized, double-blind, placebo-controlled crossover study, we investigated if a peripheral nerve block could temporarily eliminate phantom and stump pain after amputation. Amputees with constant postamputation pain were included and randomized to receive a nerve block with lidocaine 2% with adrenaline or saline in a crossover design. Spontaneous phantom and stump pain and evoked responses were assessed at baseline and at fixed time points until 120 minutes after lidocaine or saline injection. The primary outcome was the difference in absolute change between worst pain intensity, either phantom or stump pain, at baseline and at 30 minutes after lidocaine or saline injection. Twelve amputees were randomized and 9 patients were included in the analysis. The absolute change in median worst pain intensity between lidocaine and saline injection was -2.0 (IQR, -4.0-0.0) (n = 9, P = 0.12). Nine out of 9 patients reported at least some pain relief after lidocaine injection compared to only 2 out of 9 patients after saline injection (P = 0.02). Phantom pain intensity was significantly reduced after lidocaine compared with saline injection (P = 0.04), whereas there was no significant change in stump pain intensity between the two interventions (P = 0.17). In all 9 amputees, evoked responses were eliminated after lidocaine injection. Thus, our findings suggest that afferent input from the peripheral nervous system plays an important role in postamputation pain.
AB - In this randomized, double-blind, placebo-controlled crossover study, we investigated if a peripheral nerve block could temporarily eliminate phantom and stump pain after amputation. Amputees with constant postamputation pain were included and randomized to receive a nerve block with lidocaine 2% with adrenaline or saline in a crossover design. Spontaneous phantom and stump pain and evoked responses were assessed at baseline and at fixed time points until 120 minutes after lidocaine or saline injection. The primary outcome was the difference in absolute change between worst pain intensity, either phantom or stump pain, at baseline and at 30 minutes after lidocaine or saline injection. Twelve amputees were randomized and 9 patients were included in the analysis. The absolute change in median worst pain intensity between lidocaine and saline injection was -2.0 (IQR, -4.0-0.0) (n = 9, P = 0.12). Nine out of 9 patients reported at least some pain relief after lidocaine injection compared to only 2 out of 9 patients after saline injection (P = 0.02). Phantom pain intensity was significantly reduced after lidocaine compared with saline injection (P = 0.04), whereas there was no significant change in stump pain intensity between the two interventions (P = 0.17). In all 9 amputees, evoked responses were eliminated after lidocaine injection. Thus, our findings suggest that afferent input from the peripheral nervous system plays an important role in postamputation pain.
KW - Peripheral nerve block
KW - Phantom pain
KW - Postamputation pain
KW - Stump pain
U2 - 10.1097/j.pain.0000000000001536
DO - 10.1097/j.pain.0000000000001536
M3 - Journal article
C2 - 30817438
SN - 0304-3959
VL - 160
SP - 1622
EP - 1633
JO - Pain
JF - Pain
IS - 7
ER -