Silencing Neuroma Pain-Botulinum Toxin Versus Local Anesthetic Injection
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Botulinium toxin type A injection, Local Anesthesia.
- Who it may be relevant to
- Registry conditions: Pain Management, Pain, Phantom Limb Pain, Phantom Limb Pain After Amputation. Basic parameters: 18 years — 50 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Ukraine
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
SILENCE-NEUROMA Trial: Silencing Neuroma Pain-Botulinum Toxin Versus Local Anesthetic Injection in a Randomized Controlled Trial
Overview
Neuroma-related pain is a frequent and disabling condition after limb trauma and amputation. Available treatments often provide short-lasting or insufficient analgesia. The SILENCE-NEUROMA Trial is a multicenter, randomized, double-blind, active-controlled study designed to compare the efficacy and safety of botulinum toxin type A versus local anesthetic injection for the treatment of neuroma-related pain. The primary outcome is pain reduction at 8 weeks after treatment.
Detailed description
Neuroma pain following limb trauma or amputation is characterized by focal neuropathic pain, trigger-point tenderness, and significant functional impairment. Local anesthetic injections are commonly used for diagnostic and therapeutic purposes but typically provide only transient relief. Botulinum toxin type A has demonstrated analgesic properties through inhibition of neurotransmitter release and neurogenic inflammation, potentially offering longer-lasting pain relief.
This multicenter, randomized, double-blind, active-controlled trial will enroll adults with clinically and imaging-confirmed neuroma-related pain persisting for at least 3 months after limb trauma or amputation. Participants will be randomized in a 1:1 ratio to receive either ultrasound-guided botulinum toxin type A injection or ultrasound-guided local anesthetic injection using an identical technique and volume.
Participants will be followed for 24 weeks. Pain intensity will be assessed using a numerical rating scale at predefined intervals. Secondary outcomes include responder rates, neuropathic pain characteristics, pain interference, functional outcomes, analgesic consumption, durability of pain relief, and safety. The study aims to provide high-quality evidence to guide interventional pain management strategies for neuroma-related pain.
Interventions
- Drug Botulinium toxin type A injection
A single ultrasound-guided perineural injection of botulinum toxin type A (100 units diluted in 2.0 mL sterile normal saline) administered circumferentially around the imaging-confirmed neuroma using a standardized grid injection technique. The procedure is performed under sterile conditions with real-time ultrasound visualization to ensure accurate perineural placement. No additional corticosteroids or anesthetics are co-administered. - Drug Local Anesthesia
A single ultrasound-guided perineural injection of local anesthetic (ropivacaine 0.2%, 2.0 mL or bupivacaine 0.25%, 2.0 mL) administered circumferentially around the imaging-confirmed neuroma using the identical injection technique and volume as the experimental arm. The procedure is performed under sterile conditions with real-time ultrasound guidance. No corticosteroids are administered.
Primary outcome measures
- Change in neuroma-related pain intensity from baseline to Week 8 measured using the 0-10 Numeric Rating Scale (NRS) [Time frame: Baseline (prior to injection) and Week 8 (56 ± 7 days) after injection]
Eligibility criteria
Inclusion criteria
- Age ≥18 years
- History of limb trauma and/or limb amputation at least 3 months prior to enrollment
- Clinical diagnosis of neuroma-related pain with focal tenderness and positive - - Tinel sign
- Imaging confirmation of neuroma by ultrasound or MRI
- Average pain intensity ≥4 on a 0-10 Numerical Rating Scale (NRS) during the week prior to screening
- Stable analgesic regimen for at least 14 days prior to enrollment
- Ability to provide written informed consent
Exclusion criteria
- Chronic pain condition unrelated to neuroma that predominates clinical symptoms
- infection at or near the planned injection site
- Known neuromuscular junction disorders (e.g., myasthenia gravis)
- Pregnancy or breastfeeding
- Botulinum toxin treatment within the previous 4-6 months
- Planned surgical neuroma revision during the study period
- allergy or hypersensitivity to botulinum toxin or local anesthetics
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Single group
- Masking
- Double blind
- Primary purpose
- Treatment
Study locations
Ukraine · 1 center
- Superhumans War Trauma Center — Lviv
Publications
- Dmytriiev D, Liu W, Barsa M, Khomenko A, Strokan A, Pasquina PF, Cohen SP. Perineuromal hydrodissection for acute postamputation pain? An observational study in a time of war. Reg Anesth Pain Med. 2026 Jul 6;51(7):795-804. doi: 10.1136/rapm-2024-106307. PMID 39971386
Identifiers
NCT: NCT07431944 · 09v213022026