Botox-like injections give Ukrainian war amputees pain relief

By Stephen Beech

A "Botox-like" substance used to successfully treat Ukrainian war amputees could bring pain relief for millions of people, say doctors.

A retired US Army colonel and physician traveled to the war-torn country to launch a study while working alongside local doctors.

They found that botulinum toxin injections provided greater short-term relief for "phantom" limb pain than standard medical and surgical care.

The team says the study, which involved 160 amputees treated at two hospitals in western Ukraine between 2022 and 2024, could ultimately benefit millions of patients worldwide.

They explained that post-amputation pain affects most amputees.

The condition limits prosthetic use, mobility, and quality of life.

In Ukraine, it is estimated that more than 100,000 soldiers and civilians have lost limbs since Russia’s invasion in 2022.

Senior study author Professor Steven Cohen, of the Northwestern Feinberg School of Medicine in Chicago, traveled to Ukraine in 2024 to help launch the study.

He is a retired U.S. Army colonel who served four overseas tours in support of military operations.

Cohen said: “Botulinum toxin injected into painful stumps of residual limbs and around neuromas was on some outcome measures, more effective than comprehensive medical and surgical treatment at one month post-treatment."

Co-author Dr. Roman Smolynets is an anaesthesiologist and intensive care specialist at Multidisciplinary Clinical Hospital of Emergency and Intensive Care in Lviv, Ukraine.

He said: “Our results show that botulinum toxin potentially could be a powerful short-term tool for treating post-amputation pain when used alongside comprehensive medical and surgical care.

“It could be another step toward helping amputees live with less pain and more dignity.

"But always as an additional point to comprehensive medical and surgical care, not as a monotherapy.”

All the study participants were amputees treated at the First Medical Union of Lviv or Ivano-Frankivsk Regional Hospital.

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Around one-in-five received botulinum toxin injections around painful nerve endings, called neuromas, as well as standard medical and physical therapy.

The other participants received comprehensive medical and surgical treatment, including nerve blocks, physical and psychological therapy, medications and other procedures.

The research team assessed pain levels at the start of treatment and after one and three months, focusing separately on phantom limb pain - pain in the missing limb - and residual limb pain.

At one month, the botulinum toxin group experienced an average reduction of four points in phantom limb pain on a 10-point scale, compared with just one point among patients in the comparison group.

Also, after one month, 69% of patients who received botulinum toxin achieved a meaningful improvement - defined as at least a 30% reduction - in phantom limb pain, compared to only 43% in the other patient group.

But, after three months, patients who received comprehensive care showed more durable pain relief than the botulinum toxin group, consistent with previous research showing that botulinum toxin’s pain-relieving effects typically last about three months.

While botulinum toxin injections, a non-surgical treatment that alleviates pain by blocking nerve signals, are most commonly known for their use in cosmetic procedures, they are also an established tool to treat chronic pain.

For the study, published in the journal Archives of Physical Medicine and Rehabilitation, the substance was injected in a new way.

The research team used ultrasound guidance to inject botulinum toxin directly around painful nerve endings and surrounding soft tissues, rather than into muscle or skin.

The scientists believe that the targeted “peri-neuromal” approach may explain the strong short-term reduction in pain by quieting nerve activity and local inflammation.

Previous studies have shown botulinum toxin to be effective for neuropathic pain, but none have injected it around painful nerves.

The new findings suggest that botulinum toxin injections near nerves may also help relieve other types of nerve pain, such as shingles-related pain, carpal tunnel syndrome and pain following operations such as mastectomy or thoracotomy.

Cohen teamed up in Ukraine with Dr. Smolynets, who has treated thousands of soldiers and civilians injured in the war by working in the country’s largest trauma and emergency centre, and Dr. Nadiya Segin, who is pioneering the use of Botulinum toxin and nerve stimulation to treat war injuries.

Dr Smolynets is due to visit Chicago with a Ukrainian delegation to spend time with Cohen at his pain medicine clinic.

The research team says larger trials are needed to confirm their findings.

They want to explore whether repeated botulinum toxin injections over time could produce sustained benefits for post-amputation pain, as they appear to do for migraine treatment.

Cohen added: “As a retired Colonel and the father of an infantry soldier who could be deployed in future conflicts and suffered from traumatic brain injury while at the U.S. Military Academy, this research carries special personal meaning for me."