Phantom Limb Pain Improvement Post Right Lower Extremity Amputation With a Liner-type Prosthesis and Pharmacotherapy Combination: A Case Report.

Abstract

Background: Phantom limb pain is pain in a missing limb postamputation. There is no sufficient evidence for an effective drug therapy, even though various treatment methods have been tried. Apart from drug therapy, mirror therapy, proprioceptive training, and virtual reality, as well as rehabilitation with appropriate orthotics have been tried. Liner-type prostheses use a silicone liner to reduce shear forces between the skin and the orthosis and to maintain suspension function, thereby relieving pain and improving comfort and functionality for the user.

Case report: A 65-year-old man underwent amputation of his right thigh. On the 10th postoperative day, he complained of phantom limb pain centered on the amputation site. Pregabalin was started but did not alleviate his symptoms. After consultation with a physical therapist, the patient began using a liner prosthesis on the 33rd postoperative day. Symptoms gradually lessened, and positive comments were heard from the patient. Pregabalin and duloxetine were administered for a time but were soon reduced. Due to good pain control, the patient was discharged on the 46th postoperative day. After discharge from the hospital, the patient was able to continue treatment as an outpatient without his symptoms worsening, using a liner prosthesis as needed.

Conclusion: Right thigh amputation is a very physically and emotionally taxing operation for the patient. Phantom limb pain is a difficult symptom to manage, but it must be adequately controlled for the patient. We have achieved phantom limb pain improvement with a combination of pharmacotherapy and a liner prosthesis. We feel a great need for close collaboration with other professions and for a nonpharmacologic approach in addition to pharmacotherapy.