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Dextromethorphan mitigates phantom pain in cancer amputees
Ron Ben Abraham1, Nissim Marouani, Avi A Weinbroum
1Post-Anesthesia Care Unit and Acute Pain Service, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Annals of Surgical Oncology
|April 8, 2003
Summary
Dextromethorphan (DM) effectively treated phantom limb pain by targeting N-methyl-D-aspartate (NMDA) receptors. This study found significant pain reduction and improved mood in amputees receiving DM treatment.
Area of Science:
- Neuroscience
- Pharmacology
- Pain Management
Background:
- Phantom limb pain may stem from overactive N-methyl-D-aspartate (NMDA) receptors.
- Dextromethorphan (DM) is an NMDA receptor antagonist.
Purpose of the Study:
- To evaluate the efficacy of dextromethorphan (DM) in treating persistent phantom limb pain.
- To determine optimal dosing for DM in managing phantom pain.
Main Methods:
- A double-blind, placebo-controlled crossover trial involving 10 amputees with phantom pain.
- Patients received oral DM (60 or 90 mg BID) followed by open-label titration.
- A 3-month treatment phase and 1-month follow-up were conducted.
Main Results:
- All patients experienced over 50% pain reduction, improved mood, and reduced sedation.
- Doses ranged from 120 to 270 mg/day, with varying efficacy across regimens.
- Three patients discontinued prior pain medications.
Conclusions:
- NMDA receptor hyperexcitability likely contributes to phantom pain.
- Dextromethorphan (DM) at 120-270 mg/day provides satisfactory relief for phantom pain.