After an above-knee leg
amputation, a 29-year-old pregnant woman (at eight weeks gestation) reported severe PLP (consistent scores of 9 or 10 on
a 10-point
pain severity scale). The
pain persisted for more than two weeks and was not relieved by multiple regimens of
opioid and nonopioid medications, including extremely high doses of i.v.
fentanyl. On postamputation day 16, a 30-minute i.v. infusion of 200 IU of
calcitonin (salmon) was administered; the woman reported transient excruciating
pain during the final 5 minutes of the infusion. There was little overall change in her
pain status over the next three days. On postinfusion day 4, the patient reported reductions in the frequency and severity of PLP episodes, and a trend of improved PLP symptom control was noted over the next 48 hours, allowing the
pain management team to begin tapering some medication dosages and thus reduce the woman's overall
narcotic exposure. The patient was discharged to a nursing facility several weeks later with relatively stable
pain (scores of <7) on a regimen of
carbamazepine,
gabapentin, and
oxycodone. She eventually delivered a healthy full-term baby.
CONCLUSION: