Can Pregabalin prevent persistent postamputation pain? We aim to investigate whether a single preoperative dose of pregabalin followed by a month of postoperative treatment can significantly reduce the incidence of phantom pain.

Background

Up to 80% of patients undergoing lower limb amputation will experience persistent post-amputation pain. This causes significant morbidity, and is difficult to treat when established.

This pain is usually composed of stump pain and phantom pain, which is experienced in the distribution of the amputated limb. The mechanism of this pain sensation is complex, but central sensitisation, which occurs at spinal cord level, is recognised to play a central role.

Gabapentin and pregabalin are known to prevent central sensitisation in a variety of clinical and experimental settings. This is thought to be due to their ability to block voltage sensitive α₂δ channels. They have been shown to be effective for the treatment of a number of neuropathic pain conditions, including phantom pain, and also to reduce acute pain after surgery. They may be able to prevent the development of phantom pain if given pre-emptively.

Subjects

All patients having lower limb amputations and able to give their own consent for surgery will be eligible, provided they are fit for a standardised general anaesthetic and able to use patient controlled analgesia postoperatively. The standard exclusion criteria for the study medication will also be applied. We aim to recruit 60 patients to each of the two arms of the study.

If you require any help, please contact: Jeanene Douglas Email: jeanene.douglas@hnehealth.nsw.gov.au Tel: +61 (0)2 4922 3435

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