The effect of opioids on phantom limb pain and cortical reorganization

Ellena Huse, Wolfgang Larbig, Herta Flor, Niels Birbaumer

Research output: Contribution to journalArticle

Abstract

The efficacy of oral retarded morphine sulphate (MST®) was tested against placebo in a double-blind crossover design in 12 patients with phantom limb pain after unilateral leg or arm amputation. Two counterbalanced treatment phases of 4 weeks each were initiated with an intravenous test infusion of MST® or Placebo. The titration phase was 2 weeks. The dose of MST® was titrated to at least 70 mg/day and at highest 300 mg/day. Pain intensity was assessed hourly on visual analog scales during a 4-week treatment-free phase, both treatment phases and at two follow-ups (6 and 12 months). Reorganization of somatosensory cortex, electric perception and pain thresholds as well as selective attention were measured pre- and post-treatment. A significant pain reduction was found during MST® but not during placebo. A clinically relevant response to MST® (pain reduction of more than 50%) was evident in 42%, a partial response (pain reduction of 25-50%) in 8% of the patients. Neuromagnetic source imaging of three patients showed initial evidence for reduced cortical reorganization under MST® concurrent with the reduction in pain intensity. Perception and pain thresholds were not significantly altered whereas attention was significantly lower under MST®. Thus, opioids show efficacy in the treatment of phantom limb pain and may potentially influence also cortical reorganization. These data need to be replicated in larger patient samples.

Original languageEnglish
Pages (from-to)47-55
Number of pages9
JournalPain
Volume90
Issue number1-2
DOIs
Publication statusPublished - Feb 1 2001

Keywords

  • Attentiveness
  • Cortical reorganization
  • Morphine sulphate
  • Phantom limb pain
  • Psychophysical thresholds

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Neurology
  • Neuroscience(all)
  • Pharmacology
  • Clinical Psychology

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