We report the case of a 40-year-old woman referred for consultation due to pain in the scar after amputation of the 5th toe of the left foot, months of evolution and rebound to treatment on two occasions, including reoperation
Personal history included traumatic amputation of the fifth toe of the left foot without other relevant personal history.
Pain is described as a lancinating factor that increases when faced with the friction and shear (VAS = 8).
Sometimes he refers paroxysms.
Do not refer to fantastic finger data.
She was previously treated with first- and second-step analgesics and pregabalin at high doses without pain improvement and many side effects.
Physical examination revealed allodynia at the distal and external edge of the left foot, more pronounced on the scar area, DN4: 5/10.
Pain and allodynia disappear with lidocaine 1% in the scar, but this technique is very painful for the patient.
Radiography and scintigraphy of the left foot showed no abnormalities.
Iontophoresis treatment was established with 2% lidocaine but after several attempts skin burns occurred.
Since the patient reported improvement with iontophoresis, we prescribed lidocaine and prilocaine cream without any improvement.
As it does not improve, Versatis® 5% was prescribed, covering the painful scar, once a day for an interval of 12 hours.
After the first adhesive dressing, pain improved by 100%.
Upon examination one month after treatment, an Eva = 0 was obtained; the patient no longer presented allodynia and commented that the dressing provided mechanical protection for the scar.
DN4: 1/10.
The patient's global improvement impression scale scores 1 (very better).
The patient had no medication side effects after 6 months of application.
Currently, the patient has had no treatment for 4 months.
After 12 months of lidocaine patch treatment, the patient decided to discontinue patch application.
In the current examination the patient does not present pain, hyperalgesia or allodynia in the scar area despite being untreated.
