Case report of patient with vascular malformation with neuropathic pain
This 57 year old gentleman had long standing vascular malformation of the left side of the neck, head and ear, and underlying AV malformation. He presented with a form of neuropathic pain, secondary to this condition with surgery and radiotherapy which he had also received.
Symptoms of neuropathic pain in vascular malformation
He was complaining of cramp and tightening pains, phantom pains, electric shock-like pains, burning, continuous pains and poor sleep. I note he had had a trial of Gabapentin in the past but had to stop this due to adverse effects. He then started taking Temgesic as required 200 mcg sublingually.
On examination, the left ear was missing. AV malformations were noted and there was no pain on light touch but there was marked pain on pinprick sensation (hyperalgesia) on the left side of the face. This gentleman was started on Pregabalin 75 mg twice per day and continued on the Temgesic.
Treatment of neuropathic pain caused by vascular abnormality
He was seen approximately 4 weeks later. He found the Pregabalin to be of great benefit to him. He found that the effects started to wear off around lunchtime so we put him on a 75 mg t.d.s. regime. It was also very noticeable that his Temgesic (Buprenorphine) requirements had reduced as a result of using the Pregabalin. The plan is to keep him on the Pregabalin for at least the next 4-5 months and then carefully titrate it down.