Ms A, a 15-year-old individual was referred for uncontrolled pain 12 days following an above knee amputation for infective causes. She had had a peri-neural sciatic and femoral catheter, with regular multi-modal analgesia for 4 days and a morphine PCA following removal of the nerve catheter at day 6. Ms A had been without her morphine PCA for 24hrs at the time of referral and was due to be discharged the following morning.
The pain assessment involved a thorough biopsychosocial history and examination. Ms A's pain was characterised by abrupt onset of sharp, continual and severe (8/10) stump pain, with sensations of cramping, tingling, itching and telescoping in the missing limb. Examination revealed pronounced allodynia and dysaesthesia around the stump. The patient could not sleep and at times would scream inconsolably. She had been using oramorph every 2 hrs, paracetamol, ibuprofen and pregabalin.
- What are the differential diagnoses for pain after amputation?
