Please confirm that an ethics committee approval has been applied for or granted: Not relevant

Background and Aims Due to Russia’s full-scale invasion of Ukraine, the frequency of limb injuries in the overall statistics of military trauma is more than 40%. It is important to emphasize that today’s reality has brought the relatively uncommon and poorly studied phantom pain to a new level of relevance and concern.

Methods Botulinum toxin therapy for phantom pain and pain in the stump Blocking of cholinergic transmission at the level of the neuromuscular synapse. As a result, the nerve endings at the synapse level do not respond to nerve impulses (chemical denervation) Injection of the drug under the navigation USD-control and EMG-control. Injection doses:150-250 units per limb divided into 4-5 injection points (neuromas, trigger points), subcutaneous injection. Frequency of injection: once in 3-4 months

Results Injection of botulinum toxin has been shown to be effective in the treatment of various types of neuropathic pain, including phantom pain after limb amputations, which is not treated with first-line drugs This treatment technique allows the patient to get rid of pain almost completely for a long period. From a personal perspective, the use of botulinum toxin has proven to be effective in 80% of the cases among 42 military amputees Pain reduction on the scale of VAS: from 8-9 points to 3-4 points Botulinum toxin is effective treatment for hyperhidrosis of the limb stump, which ultimately significantly expands rehabilitation opportunities

Conclusions Botulinum toxin type A is a safe alternative to strong opioid therapy in cases of high-intensity PHP can significantly reduce the dose and duration of narcotic painkillers.