Phantom limb pain

Phantom Limb Pain

I saw a 64 year old gentleman in the Pain Clinic. He had a left below knee amputation. He is complaining of pain in the lateral border of the lower part of the stump and a specific point of tenderness. He described this as a sharp pain, worse on walking, and continuous. His average pain score was 3/10 and worst pain score was 5/10. He had the pain all the time and it interfered with his ability to walk.

He also mentioned that he had phantom limb pains continuously which he described as “wicked”. These went down to the (amputated) toes and, in particular, were cramping in nature. At that time he was taking Paracetamol and Co-dydramol which unfortunately were not improving his pain.

Mechanisms of Phantom Limb Pain

This gentleman had a form of neuropathic pain common with post amputees, in particular he had stump pain but also painful phantom pains. This is pain felt in the area that has been previously been amputated and commonly occurs in amputated limbs, although it also occurs in post mastectomy patients.

Despite the fact that the limb has been surgically removed, the nerves that supply the limb, albeit severed, may still be functioning and signalling back to the brain that there is pain occuring.

Treatment of Phantom Limb Pain

The gentleman was started on Pregabalin 75 mg twice a day and over the next week or so, he started to gain significant improvement with this medication. Later on, he had an injection of Chirocaine and Depo-Medrone locally to the trigger point and this gave him relief for about 2 months. He has decided to have this repeated.