A 51 year old lady was seen in the Pain Clinic. She had undergone 12 previous operations on her right ankle.
Examination findings in neuropathic ankle pain
On examination it was noted that the surgical scars were all well healed now and there were 2 large areas of pain on light touch (allodynia) and pain on pin prick (hyperalgesia) over the medial and lateral malleoli. She complained of constant burning pain in the foot going to the toes. She was taking Codeine and Tramadol.
Cause of neuropathic ankle pain
This lady was diagnosed with having localised neuropathic pain, most likely secondary to her multiple surgeries. She was given a long and frank discussion about neuropathic pain- being damage and/or dysfunction of elements of the nervous system.
Treatment of neuropathic ankle pain
She was started on a regime of Gabapentin 200 mg t.d.s. Over the next few months this was titrated up to Gabapentin 800 mg t.d.s. and she took Oxycodone 5-10 mg as required. She was also titrated up to Amitriptyline 100 mg nocte.
At 3 months following her initial diagnosis, her symptomology had improved dramatically. She had very little in the way of adverse effects and she reported having slept properly for the first time in many years.
The plan with this lady is to continue her on her present regime for the time being, with a view to keeping it at this level for at least 4-5 months and then trying to reduce this dose.