{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T01:13:20Z","timestamp":1781658800877,"version":"3.54.5"},"reference-count":22,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,2,5]]},"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:p>Neuropathic opioid refractory phantom limb pain (PLP) following amputation can be a life long debilitating chronic pain syndrome capable of completely destroying a patient\u2019s life. The pain, its associated depression and sleep deprivation can make many patients suicidal. Ever changing and relentless, it is notoriously unresponsive to traditional cocktails of strong opioids, adjuvant pain medications, antidepressants, local anaesthetics, nerve stimulators, hypnotics and psychotropics. Drug effects are seldom more effective than placebo. We describe a successful sustained rescue of a difficult 2-year-long PLP case with sublingual buprenorphine\/naloxone using the drug\u2019s potent multimodal mechanisms of action: potent long-acting mu agonist\/antagonist, kapa receptor antagonist, delta receptor antagonist and novel opioid receptor-like 1 (OR-L1) agonist effects. Traditional escalating pure mu-opioid receptor agonists and adjuvant neuropathic pain cocktails often have disappointing efficacy in the treatment of resistant PLP. We suggest introducing buprenorphine\/naloxone as an early effective opioid choice in PLP management.<\/jats:p>","DOI":"10.1136\/bcr-2020-237009","type":"journal-article","created":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T11:30:52Z","timestamp":1613734252000},"page":"e237009","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Haunting of the phantom limb pain abolished by buprenorphine\/naloxone"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8482-4741","authenticated-orcid":false,"given":"Una","family":"Srejic","sequence":"first","affiliation":[{"name":"Anesthesiology, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faried","family":"Banimahd","sequence":"additional","affiliation":[{"name":"Emergency Medicine, University of California Irvine, Irvine, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,2,19]]},"reference":[{"key":"2025082703532083000_14.2.e237009.1","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1097\/MRR.0000000000000259","article-title":"Prevalence and correlations between suicide attempt, depression, substance use, and functionality among patients with limb amputations","volume":"41","author":"Arias V\u00e1zquez","year":"2018","journal-title":"Int J Rehabil Res"},{"key":"2025082703532083000_14.2.e237009.2","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s40122-019-00143-6","article-title":"A narrative pharmacological review of buprenorphine: a unique opioid for the treatment of chronic pain","volume":"9","author":"Gudin","year":"2020","journal-title":"Pain Ther"},{"key":"2025082703532083000_14.2.e237009.3","unstructured":"Jensen TS , Nikolajsen L . Phantom pain and other phenomena after amputation. In: Wall PD , Melzack RA , eds. Textbook of Pain. 4th Ed.. Edinburgh: Churchill Livingstone, 1999: 799\u2013814."},{"key":"2025082703532083000_14.2.e237009.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.11.037"},{"key":"2025082703532083000_14.2.e237009.5","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(02)00074-1"},{"key":"2025082703532083000_14.2.e237009.6","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(80)90092-5"},{"key":"2025082703532083000_14.2.e237009.7","doi-asserted-by":"crossref","DOI":"10.7205\/MILMED-D-12-00310","article-title":"Buprenorphine\/naloxone therapy for opioid refractory neuropathic pain following traumatic amputation: a case series","volume":"178","author":"Licina","year":"2013","journal-title":"Mil Med"},{"key":"2025082703532083000_14.2.e237009.8","first-page":"CD006380","article-title":"Pharmacologic interventions for treating phantom limb pain","volume":"10","author":"Alviar","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"2025082703532083000_14.2.e237009.9","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1093\/pm\/pnz356","article-title":"Understanding buprenorphine for use in chronic pain: expert opinion","volume":"21","author":"Webster","year":"2020","journal-title":"Pain Med"},{"key":"2025082703532083000_14.2.e237009.10","unstructured":"Purdue Pharma LP . Butrans (buprenorphine transdermal system) [package insert]. Stamford CT, 2019 Oct."},{"key":"2025082703532083000_14.2.e237009.11","unstructured":"BioDelivery Sciences International Inc . Belbuca (buprenorphine buccal film) [prescribing information]. Raleigh, NC, 2019 December."},{"key":"2025082703532083000_14.2.e237009.12","first-page":"1","article-title":"Percutaneous 60-day peripheral nerve stimulation implant provides sustained relief of chronic pain following amputation: 12-month follow-up of a randomized, double-blind, placebo-controlled trial","volume":"0","author":"Gilmore","year":"2019","journal-title":"Reg Anesth Pain Med"},{"key":"2025082703532083000_14.2.e237009.13","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1213\/XAA.0000000000000893","article-title":"Ultrasound-Guided percutaneous Cryoneurolysis for postoperative analgesia after limb amputation: a case series","volume":"12","author":"Gabriel","year":"2019","journal-title":"A&A Practice"},{"key":"2025082703532083000_14.2.e237009.14","doi-asserted-by":"crossref","DOI":"10.1007\/s11916-018-0732-2","article-title":"Buprenorphine for chronic pain: a systemic review","volume":"22","author":"Fishman","year":"2018","journal-title":"Current Pain and Headache Reports"},{"key":"2025082703532083000_14.2.e237009.15","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000170"},{"key":"2025082703532083000_14.2.e237009.16","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-199505000-00030"},{"key":"2025082703532083000_14.2.e237009.17","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e31815ca2b4"},{"key":"2025082703532083000_14.2.e237009.18","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-144-2-200601170-00010"},{"key":"2025082703532083000_14.2.e237009.19","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2014.00170"},{"key":"2025082703532083000_14.2.e237009.20","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(96)03080-1"},{"key":"2025082703532083000_14.2.e237009.21","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001633"},{"key":"2025082703532083000_14.2.e237009.22","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.pmr.2020.02.001","article-title":"Buprenorphine in the treatment of chronic pain","volume":"31","author":"Rudolf","year":"2020","journal-title":"Phys Med Rehabil Clin N Am"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-237009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:53:31Z","timestamp":1756292011000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-237009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2]]},"references-count":22,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2,19]]},"published-print":{"date-parts":[[2021,2]]}},"alternative-id":["10.1136\/bcr-2020-237009"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-237009","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2]]}}}