245: Non-invasive Peripheral Neuromodulation for Managing Post-amputation Pain: a Prospective Case series

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic posttraumatic pain, Non-pharmacological treatments, Neuromodulation (e.g. TMS, TDCS, FUS, SCS, MCS, DBS, vagus nerve stimulation), Treatment/management

Background and Aims: The war between Ukraine and Russia has resulted in hundreds of thousands of casualties due to drone strikes, artillery shelling, bomb blasts and high velocity gunshot injuries. Some of these patients with life-altering injuries have required limb amputations, lower or upper or both; poorly managed pain has impacted on the quality of life, often delaying rehabilitation and mobilisation with prosthesis. Opioid management and effective invasive interventions are limited in Ukraine due to the ongoing conflict. We are reporting an update on a prospective study on the use of a patented high frequency non-invasive peripheral neurostimulation for managing post-amputation pain.

Methods: Patients received targeted high frequency peripheral neurostimulation on the amputation stump using electrode pads/ electrode wraps. The stimulation was adjusted to cover the area of pain with the stimulation strength titrated up until there was cessation perception of the pre-existing pain – phantom limb pain, stump pain, neuroma pain- but tolerating the stimulation without any discomfort. The stimulation was given for 30 minutes and follow ups were conducted at 24 hours and 48 hours and then continued monthly with ongoing treatments. Improvement in baseline pain scores, ease of mobilising, weight-bearing on the limb prosthesis and duration of walking were assessed.

Results: VAS pain scores, issues with mobilisation and other quality of life parameters including sleep hygiene had significant improvement as compared to baseline values immediately after treatment. Patients were followed up at 24 and 48 hours with the VAS score improvement maintained in most patients. Patient feedback was positive for continuing with the stimulation treatment either as outpatient or as domiciliary treatment. Improvement in stump pain, phantom-limb pain and neuroma pain enabled more mobilisation on their prostheses. More than 100 patients are currently on monthly follow up and updated results would be presented in the poster at the IASP congress.

Conclusions: This cohort comprises of military personnel who had sustained severe trauma to the limbs due to blast injury, shrapnel or high-velocity gunshot injuries which were managed with limb amputations. Mobilisation with prosthesis and quality of life were impaired due to ongoing persistent neuropathic pain and phantom-limb pain. The focus was to improve mobility, maintain sustainable pain relief and tapering of opioids and neuropathic pain medications. Pain following traumatic amputations due to battlefield injuries can be successfully managed with cost-effective non-invasive neurostimulation to enable mobilisation and improv quality of life. Lessons learnt could be applied to civilian population in the future.

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Presenting Author: Dr Arun Bhaskar
Submitting Author: Arun Bhaskar

Senior Author: Dr Arun Bhaskar

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Dr Nadiya Segin: MD - Ivano-Frankivsk Regional Clinical Hospital, Ivano-Frankivsk, Ukraine
• Dr Nelia Krekhovetska: MD - Ivano-Frankivsk Regional Clinical Hospital, Ivano-Frankivsk, Ukraine
• Dr Vitalii Lytsur: MD - . Ivano-Frankivsk Regional Clinical Hospital, Ivano-Frankivsk, Ukraine
• Khrystyna Dzvyniatska: MD - Ivano-Frankivsk Regional Clinical Hospital, Ivano-Frankivsk, Ukraine
• Olena Hryhozka: MD - Ivano-Frankivsk Regional Clinical Hospital, Ivano-Frankivsk, Ukraine
• Ostap Gryschuk: MD - Ivano-Frankivsk Regional Clinical Hospital, Ivano-Frankivsk, Ukraine
• Andriy Yavorskyy: MD - Ivano-Frankivsk Regional Clinical Hospital, Ivano-Frankivsk, Ukraine