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New Wrinkles In Phantom Pain Treatment

As the Tokyo Paralympics reached their peak in early September, there was another big global gathering with major implications for the limb-difference community. The 1st International Conference on Phantom Limb Pain (ICPLP) brought together more than a dozen heavyweight researchers from three continents to present new findings, conduct live demonstrations, and bring attention to novel treatments for phantom limb pain (PLP). Here are five unheralded but promising lines of inquiry that received an airing during the conference. More info at icplp2021.com.

1. Phantom Motor Execution

Presenter: Eva Lendaro • Chalmers University of Technology

In this approach, individuals retrain their neural pathways by executing “phantom limb movements,” such as mentally rotating the ankle of an amputated leg or flexing the wrist of an amputated arm. Lendaro presented data from the first randomized controlled trial of phantom motor execution as a PLP therapy.

2. Electroacupuncture

Presenter: Holly King • HK Physio Ltd.

As its name suggests, this treatment takes traditional acupuncture—needles placed on the body to activate qi—and adds a little juice to heighten the effect. King presented a case study of a 30-something above-knee amputee who drastically reduced his PLP levels and his dependence on painkillers. No clinical trials are currently on tap.

3. Transcranial Direct Current Stimulation (tDCS)

Presenter: Nadia Bolognini • University of Milan-Bicocca

Bolognini helped pioneer tDCS as a PLP therapy more than a decade ago, achieving short-term relief by sending targeted currents to subjects’ brains via external electrodes. Recent studies have paired tDCS with mirror-box therapy to assess whether the two treatments in tandem might produce more sustained pain relief.  

4. Botulinum Toxin Nerve Blocks

Presenter: Clay Smither • Central Virginia Veterans Affairs Hospital

Better known as botox, this treatment blunts pain by inhibiting the transmission of signals between nerves. While most commonly prescribed for patients with chronic headaches, arthritis, and spinal injuries, Smither shared two case studies in which botox suppressed intense PLP. Larger-scale studies may be in the offing.

5. Graded Motor Imagery (GMI)

Presenter: Kate Lancaster • Queen Mary’s Hospital, London

Developed by physical therapists, this intensive, hands-on treatment integrates elements of mirror therapy, phantom motor execution, and other treatments. Lancaster shared her experience over the last ten years with this practice, which has only been clinically tested in a handful of small trials.


PUTTING PAIN ON TRIAL

Cleveland-based Neuros Medical has launched its long-awaited QUEST study, a clinical trial of the company’s high-frequency nerve block technology for post-amputation pain. Dubbed Altius, the pain-management system received Breakthrough Device designation from the Food and Drug Administration earlier this year.

Notable for its size (180 subjects) and randomized, double-blind methodology, the clinical trial is expected to run through January 2022. Neuros hopes to bring Altius to market within the next few years. 

“I am hopeful that a successful trial result will enable the Altius therapy, with its unique mechanism of action achieved with high-frequency nerve block (HFNB), to become an important treatment option for post-amputation phantom and stump pain,” says Dr. Leonardo Kapural of Carolinas Pain Institute, the QUEST study’s principal investigator.

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