A dependable methodology to deal with post-amputation ache stays elusive, however a brand new Northwestern Medication examine carried out in collaboration with Ukrainian physicians means that hydrodissection – a easy process that injects fluid round nerves – could cut back residual limb ache and opioid dependence.
The examine is the primary to judge hydrodissection for post-amputation ache, a situation affecting thousands and thousands worldwide that’s notoriously troublesome to deal with.
It is going to be printed on Wednesday (Feb. 19) in Regional Anesthesia & Ache Medication.
Including hydrodissection to opioid remedy for post-amputation ache not solely seems to enhance ache outcomes, but additionally exhibits mental-health advantages.”
Dr. Steven P. Cohen, senior examine creator, professor of anesthesiology and the vice chair of analysis and ache drugs, Northwestern College Feinberg College of Medication
For younger veterans, discovering safer options to opioids is very essential, mentioned Cohen, a retired U.S. Military colonel who traveled to Ukraine to assist arrange the examine. Many face a excessive threat of opioid dependence attributable to extreme psychological trauma.
How the examine was carried out
Scientists adopted 74 Ukrainian troopers and civilians who had undergone traumatic limb amputations attributable to battle accidents. Thirty-eight sufferers acquired hydrodissection alongside opioid remedy inside six months of amputation, whereas 36 acquired opioids alone.
The examine confirmed that hydrodissection mixed with opioids supplied higher ache reduction and decreased opioid use. On a 0–10 ache scale, the hydrodissection group reported a median ache discount of 4 factors, in comparison with 3 factors for these on opioids alone – a major distinction thought of clinically significant in most research.
Moreover, almost two-thirds of sufferers within the hydrodissection group decreased their opioid use, whereas solely about one-third of the opioid-only group did. Sufferers receiving hydrodissection additionally reported decrease anxiousness ranges. Nonetheless, its results on phantom limb ache and continual ache have been extra restricted.
Findings are ‘extremely related to Individuals’
Submit-amputation ache is a serious problem for each veterans and civilians worldwide, typically stopping amputees from utilizing prosthetics and decreasing their high quality of life.
An estimated 100,000 Ukrainians have suffered war-related amputations since Russia’s full-scale invasion of Ukraine. Within the U.S., greater than 2 million individuals dwell with limb loss, a quantity that’s anticipated to rise sharply attributable to growing old populations and rising charges of diabetes and vascular illness.
“This analysis is extremely related to Individuals,” Cohen mentioned. “Trauma is the main explanation for upper-extremity amputations worldwide, and post-amputation ache impacts most amputees, limiting their reintegration into society.”
Hydrodissection is remarkably easy
Hydrodissection is an ultrasound-guided process the place fluid is injected into scar tissues round nerves to alleviate stress, cut back irritation and promote therapeutic. Whereas the method has proven promise for acute and neuropathic ache, its effectiveness for post-amputation ache, particularly, had not been beforehand studied.
“It is exceptional how easy and accessible this method is – requiring simply an ultrasound and a needle. It may be simply adopted by most group hospitals within the U.S.,” mentioned Cohen.
Returning to Ukraine
Given the challenges of conducting analysis throughout wartime, the examine was exploratory, not managed. Nonetheless, Cohen intends to return to Ukraine this spring to launch new randomized trials centered on novel remedies for post-amputation ache, traumatic mind harm, and PTSD – undeterred by the hazards of working in a battle zone.
A veteran of 4 abroad excursions in help of navy operations and a father to a son presently serving within the infantry, Cohen can be analyzing information on botulinum toxin injections for amputees and inspecting how psychological well being components, equivalent to despair and anxiousness, impression phantom limb ache and restoration outcomes.
The opposite examine authors are Dr. Dmytro Dmytriiev who’s a pioneer on the usage of hydrodissection for postamputation ache, Winnie L. Liu, Dr. Maksym Barsa, Dr. Andreii Khomenko, Dr. Andreii Strokan and Dr. Paul F. Pasquina.
This analysis was partly supported by the U.S. Dept. of Protection and Uniformed Providers College, Division of Bodily Medication & Rehabilitation.
Supply:
Journal reference:
Dmytriiev, D., et al. (2025) Perineuromal hydrodissection for acute postamputation ache? An observational examine in a time of battle. Regional Anesthesia & Ache Medicine. doi.org/10.1136/rapm-2024-106307.
