How ‘Botox’ is helping Ukrainian soldiers who’ve lost limbs in the war

Here’s one way to think outside the ‘tox.

Botox is a brand name for a purified form of botulinum toxin A, a protein that temporarily paralyzes muscles by blocking the nerve signals that cause them to contract. The injections are used for everything from smoothing wrinkles to easing chronic migraines and relaxing overactive bladder muscles.

Now Northwestern Medicine and Ukrainian physicians have now identified another potential use for Botox — relieving devastating phantom limb pain in Ukrainian war amputees.

“Our results show that botulinum toxin could be a powerful short-term tool for treating post-amputation pain when used alongside comprehensive medical and surgical care,” said Dr. Roman Smolynets, an anesthesiologist and intensive care specialist at Multidisciplinary Clinical Hospital of Emergency and Intensive Care in Lviv, Ukraine.

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

Managing pain after amputation

Estimates suggest that tens of thousands of Ukrainian soldiers and civilians have lost limbs since Russia’s full-scale invasion began in 2022.

Most amputees suffer phantom limb pain — pain in the missing limb — and residual limb pain — pain in the remaining part of the limb.

Amputee limb pain often requires a multi-pronged strategy. Surgery is used to address underlying nerve issues. Medications can manage pain signals, while physical therapy can improve strength and function.

The study authors wanted to see how botulinum toxin fared as an approach.

Physicians treated 160 amputees at two hospitals in western Ukraine from 2022 to 2024.

About 20% received botulinum toxin injections around painful nerve endings, along with medical and physical therapy. The rest of the participants simply underwent medical and surgical treatment.

How ‘Botox’ may help

The researchers found that the “Botox” group improved their phantom limb pain by an average of 40% after one month, while the other participants only reported a 10% boost.

In total, 69% of the botulinum toxin patients experienced at least a 30% decrease in their phantom limb pain compared to 43% of their peers in the other group.

Dr. Steven P. Cohen, a professor of anesthesiology and the vice chair of research and pain medicine at Northwestern University Feinberg School of Medicine, told The Post that the only “Botox” side effect was temporary pain.

Unfortunately, the positive effects of “Botox” were fleeting.

At three months, the botulinum toxin recipients fell behind the other group in pain relief, which makes sense since the effects of Botox tend to fade after three or four months.

It’s unclear whether repeat injections could provide long-term benefits. The physician team hopes that’s the subject of future study, along with experimentation on dose amounts and patient selection criteria.

“The next study follows people for one year, separating out their residual limb (stump) pain and phantom limb pain and seeing how they are associated with anxiety, depression and quality of life,” said Cohen, a retired US Army colonel who served four overseas tours in support of military operations.

What’s next  for amputees

The findings, published Tuesday in the journal Archives of Physical Medicine and Rehabilitation, may eventually benefit the 2 million-plus Americans believed to have limb loss.

Smolynets and Cohen noted that the “Botox” treatments helped some amputees better use their prosthetics and walk around.

The pair credits the short-term easing of pain to the way the Botox was injected.

Botox is typically pumped into muscle, but the researchers injected the toxin directly around nerve endings and surrounding soft tissues to calm nerve activity and reduce local inflammation.

This technique may help alleviate other forms of nerve pain, like from shingles and carpal tunnel syndrome.

As the Ukraine war drags on, Smolynets and Cohen are also testing novel war treatments for traumatic brain injury and PTSD.