{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:17:38Z","timestamp":1790173058050,"version":"4.1.0"},"reference-count":41,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:00:00Z","timestamp":1739923200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009898","name":"Defense Health Agency","doi-asserted-by":"publisher","award":["HU00011920011"],"award-info":[{"award-number":["HU00011920011"]}],"id":[{"id":"10.13039\/100009898","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2025,1,22]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This exploratory study investigates the potential of perineuromal hydrodissection as an adjunct to opioid therapy for postamputation pain, specifically focusing on residual limb and phantom limb pain (PLP). Given the correlations between acute pain and the development of chronic pain, the primary aims were to estimate the effect size of early hydrodissection of scar tissue around residual limb neuroma(s) and to identify the best time frame for treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Seventy-four patients with war-related limb amputations and painful neuromas were included in this observational analysis. Thirty-eight Ukrainian patients with war-related limb amputation and a painful neuroma(s) who underwent hydrodissection and opioid therapy within 6 months of amputation were compared with 36 patients who received opioids alone. Co-primary outcome measures were median reduction from baseline in average residual limb and PLP at 12 weeks. The composite positive outcome was designated as a \u22652-point decrease or 30% reduction in average residual limb and PLP, satisfaction with treatment, and not requiring an increase in analgesics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Hydrodissection as an add-on to opioids resulted in a greater reduction in average residual limb pain at 12 weeks (\u22122.00\u00b11.00 vs \u22121.00\u00b11.00; p&lt;0.001) and earlier time periods, but PLP only through 4 weeks. At 12 weeks, Hospital Anxiety and Depression Scale anxiety (10.00\u00b12.00 vs 11.00\u00b11.00; p&lt;0.001) but not depression score was lower in the hydrodissection group. Opioid use in the hydrodissection group significantly declined from 41.32\u00b19.63\u2009to 33.42\u00b18.78 morphine equivalents per day (p=0.001) over the study, but not in the opioid-only group (p=0.20). Differences in 12-week satisfaction rates were not significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This exploratory study suggests perineuromal hydrodissection may improve residual limb pain and to a lesser degree phantom limb pain, particularly when implemented early in the course of postamputation pain. The study provides preliminary effect size estimates and identifies acute pain as a potential characteristic of patients who may respond more favorably to this intervention. Randomized controlled trials are needed to confirm these findings and control for the confounding variables identified.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2024-106307","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T09:10:14Z","timestamp":1739956214000},"page":"795-804","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Perineuromal hydrodissection for acute postamputation pain? An observational study in a time of war"],"prefix":"10.1136","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6067-681X","authenticated-orcid":false,"given":"Dmytro","family":"Dmytriiev","sequence":"first","affiliation":[{"name":"Anesthesiology and pain medicine, Vinnitskij Natsionalnij Medichnij Universitet, Vinnitsiya, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winnie","family":"Liu","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maksym","family":"Barsa","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Semenyuk Rivne Regional Clinical Hospital, Rivne, Ukraine"},{"name":"Dept of Anesthesiology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreii","family":"Khomenko","sequence":"additional","affiliation":[{"name":"Dept of Anesthesiology and Intensive Care, Feofaniya Clinical Hospital of the State Management of Affairs of Ukraine, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreii","family":"Strokan","sequence":"additional","affiliation":[{"name":"Dept of Anesthesiology and Intensive Care, Feofaniya Clinical Hospital of the State Management of Affairs of Ukraine, Kyiv, Ukraine"},{"name":"Department of Anesthesiology, Intensive Care Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul F","family":"Pasquina","sequence":"additional","affiliation":[{"name":"Dept of Physical Medical & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5928-2127","authenticated-orcid":false,"given":"Steven P","family":"Cohen","sequence":"additional","affiliation":[{"name":"Dept of Physical Medical & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA"},{"name":"Anesthesiology, Neurology, Physical Medicine & Rehabilitation, Psychiatry and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,19]]},"reference":[{"key":"2026071002301586000_51.7.795.1","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1097\/j.pain.0000000000003094","article-title":"A systematic review of the prevalence of postamputation and chronic neuropathic pain associated with combat injury in military 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