Chronic phantom limb pain: the effects of calcitonin, ketamine, and their combination on pain and sensory thresholds

Eichenberger, Urs; Neff, Frank; Sveticic, Gorazd; Björgo, Steinar; Petersen-Felix, Steen; Arendt-Nielsen, Lars; Curatolo, Michele (2008). Chronic phantom limb pain: the effects of calcitonin, ketamine, and their combination on pain and sensory thresholds. Anesthesia and analgesia, 106(4), 1265-73, table of contents. Hagerstown, Md.: Lippincott Williams & Wilkins 10.1213/ane.0b013e3181685014

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BACKGROUND: Calcitonin was effective in a study of acute phantom limb pain, but it was not studied in the chronic phase. The overall literature on N-methyl-D-aspartate antagonists is equivocal. We tested the hypothesis that calcitonin, ketamine, and their combination are effective in treating chronic phantom limb pain. Our secondary aim was to improve our understanding of the mechanisms of action of the investigated drugs using quantitative sensory testing. METHODS: Twenty patients received, in a randomized, double-blind, crossover manner, 4 i.v. infusions of: 200 IE calcitonin; ketamine 0.4 mg/kg (only 10 patients); 200 IE of calcitonin combined with ketamine 0.4 mg/kg; placebo, 0.9% saline. Intensity of phantom pain (visual analog scale) was recorded before, during, at the end, and the 48 h after each infusion. Pain thresholds after electrical, thermal, and pressure stimulation were recorded before and during each infusion. RESULTS: Ketamine, but not calcitonin, reduced phantom limb pain. The combination was not superior to ketamine alone. There was no difference in basal pain thresholds between the amputated and contralateral side except for pressure pain. Pain thresholds were unaffected by calcitonin. The analgesic effect of the combination of calcitonin and ketamine was associated with a significant increase in electrical thresholds, but with no change in pressure and heat thresholds. CONCLUSIONS: Our results question the usefulness of calcitonin in chronic phantom limb pain and stress the potential interest of N-methyl-D-aspartate antagonists. Sensory assessments indicated that peripheral mechanisms are unlikely important determinants of phantom limb pain. Ketamine, but not calcitonin, affects central sensitization processes that are probably involved in the pathophysiology of phantom limb pain.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
UniBE Contributor:	Eichenberger, Urs, Sveticic, Gorazd, Curatolo, Michele
ISSN:	0003-2999
ISBN:	18349204
Publisher:	Lippincott Williams & Wilkins
Language:	English
Submitter:	Jeannie Wurz
Date Deposited:	04 Oct 2013 14:58
Last Modified:	05 Dec 2022 14:18
Publisher DOI:	10.1213/ane.0b013e3181685014
PubMed ID:	18349204
Web of Science ID:	000254260200035
URI:	https://boris.unibe.ch/id/eprint/25067 (FactScience: 55217)