OBJECTIVE

To evaluate the efficacy of abobotulinumtoxinA in stump preparation for prosthetic fitting in patients with limb amputations.

MATERIAL AND METHODS

This prospective open-label study included 88 male patients over 18 years old with lower limb amputations due to mine-blast trauma and phantom limb pain syndrome (PLP) with pain intensity of at least 5 points on the visual analogue scale (VAS), absence of significant effect from pharmacological therapy, stump tenderness, and preserved active movements in the transected muscles. AbobotulinumtoxinA at doses of 500—800 U was used to reduce PLP severity. Examination of all patients included collection of complaints and medical history, neurological examination (including manual muscle testing and muscle tone assessment), pain assessment by VAS, psycho-emotional status assessment using the Hospital Anxiety and Depression Scale (HADS), neuropathic pain assessment using the DN4 questionnaire, and stump ultrasound to assess muscle functional status (presence or absence of movements). The total observation period was 21 days. Seven patients with preserved muscles were additionally examined 3 months after botulinum toxin injection.

RESULTS

Baseline VAS pain score was 5.8±0.4 points. Clinically significant anxiety according to HADS was present in 86 patients. The mean anxiety score before botulinum toxin injection in the group was 9.1±1.2 points. Depression scores on the HADS were subclinical in all patients, with a mean of 5.3±1.6 points. The mean DN4 neuropathic pain score was 5.9±0.5 points. Pain intensity decreased in all patients, reaching a mean of 3.7±0.5 points on VAS by day 7 after botulinum toxin therapy (p<0.05). By day 14, pain syndrome was completely resolved in all patients. The mean DN4 score was 5.1±0.4 points on day 7 and 2.6±0.9 points on day 14 after injection (p<0.05).

CONCLUSIONS

Early botulinum toxin therapy enables rapid stump preparation for prosthesis fitting, resolves pain syndrome and accelerates patient rehabilitation.