A new study has suggested that hydrodissection—a simple procedure that injects fluid around nerves—may reduce residual limb pain and opioid dependence after amputation.
“Adding hydrodissection to opioid treatment for post-amputation pain not only appears to improve pain outcomes, but also shows mental health benefits,” said senior study author Steven P. Cohen, MD, a professor of anesthesiology and the vice chair of research and pain medicine at Northwestern University Feinberg School of Medicine.
Hydrodissection is an ultrasound-guided procedure where fluid is injected into scar tissues around nerves to relieve pressure, reduce inflammation, and promote healing. While the technique has shown promise for acute and neuropathic pain, its effectiveness for post-amputation pain, specifically, had not been previously studied.
For young veterans, finding safer alternatives to opioids is especially crucial, because many face a high risk of opioid dependence due to severe psychological trauma, Cohen said.
Cohen, who traveled to Ukraine to set up the study in collaboration with Ukrainian physicians, is a retired United States Army colonel who served four overseas tours in support of military operations and father to a son in the US infantry.
The scientists followed 74 Ukrainian soldiers and civilians who had undergone traumatic limb amputations due to war injuries. Thirty-eight patients received hydrodissection alongside opioid therapy within six months of amputation, while 36 received opioids alone.
The study showed that hydrodissection combined with opioids provided better pain relief and reduced opioid use. On a zero to ten pain scale, the hydrodissection group reported an average pain reduction of four points, compared to three points for those on opioids alone, a difference considered clinically meaningful in most studies.
Additionally, nearly two-thirds of patients in the hydrodissection group reduced their opioid use, while only about one-third of the opioid-only group did. Patients receiving hydrodissection also reported lower anxiety levels. However, its effects on phantom limb pain and chronic pain were more limited.
Cohen is also analyzing data on botulinum toxin injections for people with amputations and examining how mental health factors, such as depression and anxiety, impact phantom limb pain and recovery outcomes.
Editor’s note: This story was adapted from materials provided by Northwestern University.
The open-access study, “Perineuromal hydrodissection for acute postamputation pain? An observational study in a time of war,” was published in Regional Anesthesia & Pain Medicine.
