Phantom limb pain

A 36-year-old male fractured his distal tibia following a motor vehicle accident 5 years prior to presentation and developed foot pain. Surgical fixation did not alleviate the pain which worsened and spread to his leg (below the knee). Treatments including analgesics, physical therapy, sympathetic blocks, and spinal cord stimulation were unsuccessful. Due to persistent pain, an above the knee amputation was performed 4 years following the initial injury. The pain abated for 2 weeks, but painful symptoms developed in the missing left leg and gradually worsened. The pain symptoms were continuous and described as “aching, tightening, and burning,” mainly localized to the distal third of the lower leg and foot. He also reports intermittent twitching and spasms at the stump. He currently takes methadone 20 mg twice a day, cymbalta 60 mg at bedtime, and baclofen 20 mg three times a day with partial benefit. 1. What is postamputation pain? A variety of unpleasant sensations are experienced after limb amputation, also known as “postamputation pain” (PAP). This was first formally described as a medical problem by Paré in 1551. In 1871 Weir Mitchell described it in Civil War soldiers and termed it “phantom limb pain” (PLP). There are three different sensory experiences described after amputation: (1) non-noxious phantom sensation, (2) residual limb pain (stump pain) (RLP), and (3) phantom pain. Phantom pain commonly involves the limbs, but it can present as “phantom breast,” “phantom tooth,” “phantom testes,” or “phantom (body part)” surgical amputation pain.