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Roberto Casale, MD1, Francesco Ceccherelli, MD2, Alaa Abd Elaziz Mohamed Labeeb, MD,PhD1,3 and Gabriele E. M. Biella, MD, PhD4

1-Department of Clinical Neurophysiology and Pain Rehabilitation Unit, “Salvatore Maugeri” Foundation, IRCCS Montescano, Pavia,

2-Department of Pharmacology and Anesthesiology, Anesthesiology Unit, University of Padova, Padova, Italy, 3-Department of Physical Medicine, Rheumatology and Rehabilitation Unit, Menoufyia University, Menoufyia,Egypt 4-Institute of Bioimaging & Molecular Physiology, IBFM, National Research Council, Segrate, Milan, Italy

Objective: To ascertain the existence of contralateral painful muscle areas mirroring phantom pain and to evaluate the short-term effects of anaesthetic vs saline, injected contralaterally to control phantom and phantom limb pain.

Design: Double-blinded cross-over study.

Setting: Inpatients; rehabilitation institute.

Participants: Eight lower limb amputees with phantom limb pain in the past 6 months.

Interventions: Either 1 ml of 0.25% bupivacaine or 0.9% saline injected alternately in each point with a 28-gauge needle, with 72 h between injections.

Main outcome measure: Phantom sensation modification and the intensity of phantom limb pain (visual analogue scale) before and after injections.

Results: Although present, painful muscle areas in the healthy limb do not mirror the topographical distribution of phantom limb pain. Sixty minutes after the injection, a statistically significant greater relief of phantom limb pain was observed after using local anaesthetic than when using saline injection (p = 0.003). Bupivacaine consistently reduced/abolished the phantom sensation in 6 out of 8 patients. These effects on phantom sensation were not observed after saline injections.

Conclusion: Contralateral injections of 1 ml 0.25% bupivacaine in myofascial hyperalgesic areas attenuated phantom limb pain and affected phantom limb sensation. The clinical importance of this treatment method requires further investigation.

J Rehabil Med 2009; 41: 418–422


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