Calcitonin for phantom limb pain in a pregnant woman.

PURPOSE

The use of calcitonin to relieve severe, treatment-refractory phantom limb pain (PLP) is reported.

SUMMARY

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

reduction in the frequency of PLP attacks and a lessening of pain intensity were observed after administration of calcitonin (salmon) by i.v. infusion in a pregnant patient. Calcitonin therapy was not associated with any apparent long-term adverse effects to the patient or infant.