Integrating botulinum toxin therapy into the rehabilitation of a patient with phantom limb pain: a case report

Background. Phantom limb pain is one of the most complex chronic pain conditions in patients after limb amputation and significantly limits functional recovery, adaptation to prosthetic use, and overall quality of life. Conventional pharmacological approaches often fail to provide sufficient analgesia, which necessitates the search for alternative and adjunctive treatment options, including the use of botulinum toxin type A. The relevance of this problem has increased substantially in the context of the war in Ukraine, which has led to a sharp rise in the number of traumatic amputations, while clinically documented cases and structured rehabilitation protocols for phantom pain remain limited. This situation highlights the need for a multidisciplinary and evidence-based approach to pain management and rehabilitation. Purpose – to demonstrate the clinical effectiveness and safety of botulinum toxin type A as part of a comprehensive treatment and rehabilitation program in a patient with phantom limb pain following bilateral traumatic lower limb amputation. Materials and Methods. A clinical case of a patient with phantom and neuropathic pain syndrome after bilateral traumatic amputation of the lower limbs is presented. Functional assessment was performed in accordance with the International Classification of Functioning, Disability and Health using standardized clinical scales, including the visual analogue scale for pain, the Hospital Anxiety and Depression Scale, the Barthel Index, the Oswestry Disability Index, and the Lovett scale, as well as instrumental examination methods. Treatment included injections of botulinum toxin type A according to a standardized botulinum therapy protocol, combined with an individualized physical rehabilitation program. Results. During the course of treatment, a clinically meaningful reduction in pain intensity was observed, reflected by changes in pain-related functional qualifiers within the International Classification of Functioning framework. A decrease in the severity of flexion contracture of the right hip joint, an increase in the range of motion, and improvement in muscle tone of the proximal segments of the lower limbs were documented. Postural stability in the sitting position and the ability to transfer using assistive devices improved. Positive changes were also noted in self-care activities and partial adaptation to daily living tasks. Environmental factors, particularly access to mobility assistive devices and family support, acted as significant facilitating factors in the rehabilitation process and contributed to creating favorable conditions for further prosthetic training. Conclusions. The use of botulinum toxin type A in patients with phantom limb pain can be considered an effective component of a multimodal treatment strategy, enabling pain reduction and enhancing the effectiveness of rehabilitation interventions. The presented clinical case underscores the feasibility of integrating botulinum therapy into medical rehabilitation programs for patients after limb amputation and supports the need for further systematic research in this field.