Abstract
<jats:p>Background. Post-amputation pain remains highly prevalent and often refractory to conventional treatment. In clinical practice, a myofascial pain component related to active myofascial trigger points (MTrPs) is frequently identified in the residual limb and adjacent compensatory muscles. Persistent myofascial nociceptive input may contribute to pain chronicity and functional limitation. The purpose was to evaluate the clinical effectiveness and safety of MTrP-directed botulinum toxin type A therapy in patients with chronic post-amputation pain. Materials and methods. In this prospective observational study, 44 adult patients with post-amputation pain lasting ≥ 3 months underwent standardized myofascial assessment. Active trigger points were identified in the residual limb and/or proximal muscles. Botulinum toxin type A was injected intramuscularly into active MTrPs, with optional ultrasound guidance. The primary outcome was pain intensity measured using a 0–10 Numeric Rating Scale. Secondary outcomes included sleep quality, prosthesis tolerance, neuropathic pain features, analgesic consumption, Patient Global Impression of Change score, and safety. Outcomes were assessed at baseline and at 6-week follow-up. Results. Mean pain intensity decreased significantly from 6.8 ± 1.1 at baseline to 3.9 ± 1.6 at follow-up (p < 0.001). A clinically meaningful pain reduction (≥ 30 %) was achieved in 61 % of patients. Improvements were observed in sleep quality (57 %), prosthesis wearing time (54 %), and analgesic use reduction (46 %). No serious adverse events were reported. Conclusions. MTrP-directed botulinum toxin type A therapy was associated with clinically relevant pain reduction and functional improvement in patients with post-amputation pain. These findings support further randomized controlled trials to confirm efficacy and optimize treatment protocols.</jats:p>