Transtibial Amputation to Address Medical Diagnosis of Neuropathic Pain: A Case Report

Background and Purpose: Neuropathic pain is estimated to impact 10% of the United States population [20]. During subjective questioning, 17% of individuals with neuropathic pain stated their quality of life was, “worse than death” [69]. Therefore, diagnosing and providing purposeful intervention to people with neuropathic pain is of great importance. The purpose of this case study is to explore a patient’s neuropathic pain experience, mechanisms of his pain, and interventions used to relieve his pain. Case Description: This case report is about a male patient who arrived at an inpatient rehabilitation facility post left transtibial amputation. He had an extensive medical history of chronic neuropathic pain, loss of function, and medical interventions used to alleviate his symptoms. When these interventions failed, the patient and physician felt the last resort was transtibial amputation. Outcomes: Immediately following the surgery, the patient described his pain verbally as 0/10, but eventually, developed phantom pain. He was discharged from the inpatient rehabilitation facility due to his independent care of residual limb and safe ambulation. On a phone call two months after discharge, the patient stated his phantom pain had continued to decrease in frequency. However, he struggled with depressive thoughts and with the difficulty of ambulation. He anticipated training with this prosthetic limb to recover meaningful functional activities. Discussion: Pain is a complicated and multifaceted human experience. This case report examines evidence for amputation, mechanisms of pain, peripheral nerve injuries, pathophysiology of neuropathic pain, cortical reorganization which may influence phantom limb pain, and neuropathic pain interventions. It then discusses the patient’s case with considerations to this research. This case report presents a patient’s experience with chronic neuropathic pain so debilitation that loss of a limb was preferable to living with intense pain daily. The intervention of amputation was hopeful for not only the relief that the patient may find, but also of the function he may gain.