A 65-year-old male patient with a spinal cord stimulation electrode (SEM) for pain control secondary to ischemia due to peripheral arteriopathy and vasodilatation induction.
Despite therapeutic efforts, the disease progressed poorly to amputation of the right lower limb in November 1998.
One month later, the patient complained of symptoms compatible with phantom limb pain.
The patient was started on dual anticonvulsant therapy, antidepressants and minor analgesics, and adjustment of the EEM parameters.
Pain was partially controlled, but episodes of lancinating pain persisted with a visual analog scale (VAS) = 8.
In 2005, patients seek medical care preferentially at the digestive medicine service because they have EMS and are possibly involved in the management of scalpel with diathermy for endoscopic polypectomy.
When considering the specifications of the midwifery care unit, the impossibility of using short-wave diathermy and microwave diathermy is indicated, since it could cause damage to the tissue that could harm the patient.
The use of bipolar electrocoagulation was then recommended.
The gastroenterology service commented that endoscopic polypectomy with bipolar electrocauterization cannot be performed; furthermore, after consultation with the general surgery service, it was considered that only a previous anatomopathological colectomy biopsy should be performed.
Given this clinical situation, it was decided to assess the actual effectiveness of EEM after 7 years of operation and, in case of ineffectiveness, proceed to its removal in order to perform endoscopic polypectomy using standard diathermy.
For this purpose, the MET was erased and the patient was cited for evaluation after 1 month.
At this appointment the patient evaluated her baseline pain with VAS = 4 with episodes of paroxysmal pain VAS = 7.
The degree of disability was similar when the electrode was lightened or crushed.
After 6 months of follow-up with the apagated electrode and without changes in the clinical situation, we decided to remove the EEM and proceed to endoscopic polypectomy.
Phantom limb pain worsened over the years with partial response to anticonvulsants and antidepressants.
The patient continued with a baseline VAS of 4 and increasingly frequent episodes of lancinating pain of 10.
Regarding their quality of life, the Lattinen index offered a value of 12 and, in addition, the patient was depressed and affected his family life.
Having reviewed the literature, we decided to cite a 0.4 mg/kg dose for continuous infusion over 60 min in daily sessions for 1 week.
Midazolam 1 mg was administered as premedication.
The only adverse events reported by the patient during infusions were dizziness and somnolence.
The patient was evaluated one week, three months and six months later, with a VAS at 6 months of 0 at rest and with a decrease in episodes of lancinating pain lasting less than 2 weeks.
The patient was discharged from the unit after one year of follow-up, given the almost complete abolition of the condition without medication.
