Long-Lasting Reduction of Phantom Limb Pain Following Pharmaceutical Blockade of the Brachial Plexus

Dear Pain Matters blog readers,

More hope for Phantom Limb Pain sufferers…

Phantom Limb Pain was reduced for a long time (in fact, 6 months) in one patient following pharmaceutical blockade of the brachial plexus.  

Prior to this single temporary blockade, this patient had suffered years of Phantom Limb Pain and cramping of his immovable phantom hand.

During a diagnostic axillary blockade of the brachial plexus, the patient experienced a reduction of Phantom Limb Pain for the first time in years.  The muscles in his phantom hand became relaxed and the ‘cramping’ in his phantom hand was also 100% eliminated.

The reduction in Phantom Limb Pain was accompanied by blockade-induced cortical reorganisation in the primary somatosensory cortex (i.e. re-reorganisation).

In summary, the good news:

The beneficial effects of a sole blockade of the brachial plexus were long-lasting (extending out to 6 months after a single temporary blockade) in this one patient.

Given the long-lasting therapeutic effects of the Brachial Plexus Blockade in this patient, it is likely that his Phantom Limb Pain was (at least in part) caused by peripheral mechanism(s).

The mechanisms underlying Phantom Limb Pain may vary from one patient to the next, and may either be peripherally– and/or centrally-mediated.  Once (pain-inducing) mechanisms are identified, pain treatment options may be tailored to each patient, hopefully leading to reduced pain levels as well as improved function and well-being.

(Possible mechanisms underlying chronic pain will be discussed in future blog posts.)

‘DEREK’, AND HIS NERVE BLOCK FOR PHANTOM LIMB PAIN

Another patient, ‘Derek’ (see below Youtube that shows 4 pain patients) had severe Phantom Limb Pain before he was offered a Nerve Block.  Derek’s Phantom Limb Pain had resulted due to amputation above his left knee following a blast while deployed in Iraq.  

The pain-reducing effects of a Nerve Block were amazing, and gave Derek a new lease on a life with significantly reduced Phantom Limb Pain and increased mobility (that even included long-distance running via a specially-designed prosthesis).  

Regarding the successful pain-relieving effects of his Nerve Block, Derek states (quoting; go to 27:43 in the Youtube, below):

“….At that moment, it was instant pain relief for me.”

Thus, Derek’s Nerve Block offered instant and complete pain relief.  This suggests that the mechanisms underlying Derek’s nerve pain including Phantom Limb Pain were completely peripherally-mediated (more on pain mechanisms later). 

Wishing you ALL a great, pain-free day,

Sabina Walker

References (NB This is not a complete list of References):

(1) Preißler et al; Brachial Plexus Block in Phantom Limb Pain: A Case Report; Pain Medicine (Nov 2011); Vol 12 (11); 1649–1654;

DOI: 10.1111/j.1526-4637.2011.01247.x

http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2011.01247.x/abstract

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