Background & Aims
Phantom limb pain refers to the presence of pain in an absent extremity and is classified as neuropathic pain, the incidence is very variable and reports figures ranging from 2 to 80%. There are factors that do not allow for underdiagnosis, such as: a feeling of mental illness on the part of the patient, which causes them to not seek help, making it difficult for the doctor to classify pain.
Management is carried out with neuropathic pain protocols, however in certain cases refractory pain can be a problem and generate a negative impact on the quality of life of these people. The refractory condition is considered when, despite using all possible treatments, the pain continues or when the treatments through their adverse effects are weighing the balance more at risk than at benefit.
The objective of this clinical case is to present advanced pain management, which presents itself as a solution that should be investigated with more effort to standardize protocols.
Methods
The management of a case is presented and the evidence surrounding the management of refractory pain in phantom limb syndrome is discussed.
Results
A female patient, 30 years old, is presented with amputation due to multiple traumatic and infectious complications. . She is a patient undergoing prosthetics, the pain has been evolving for 5 years, she has been treated with neuromodulators, NSAIDs and opioids, with low tolerance.
If you decide to use ketamine + lidocaine in intravenous infusion, ketamine is used in a single 5-hour infusion, at a dose ranging from 0.1mg to 0.5mg/kg/h and as an adjuvant for adverse events, Dexmedetomidine is used.
Ademas uses lidocaine in doses ranging from 1 to 5 mg/kg/h, in one-hour infusions for 5 consecutive days.
Tolerance was excellent, using a top dose of ketamine from the second hour of infusion and no need for rescates of dexmedetomidine, with lidocaine, when using a top dose from the third day of infusion.
After 24 hours: pain reduction from 9-10 to 0-1.
After the first week the effect is maintained and lasts for 3 months where a new infusion is suggested.
Conclusions
The management of neuropathic pain is complex, especially when the therapeutic arsenal is not sufficient, although the need to resolve the pain is indispensable.
The use of advanced therapeutic strategies should be an option for patients with refractory and severe pain, with all precautions, in this case the patient enters the outpatient pain clinic in Support and remains monitored and monitored at all times.
The result at the level of evidence is variable, although the protocols used are also variable, which is why it is necessary to increase research, generate transnational networks to address this topic.
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Presenting Author
Fausto Gady Torres Toala
Poster Authors
Fausto Gady Torres Toala
Md. MPH
SuportaMed
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Pain in Amputees