This module covers a veteran with phantom limb pain named Peter James. He's a 49-year-old veteran of the reserves injured by an IED in Afghanistan. His lower left leg was amputated at Walter Reed.
Before he was in the reserves, Peter James was a stone mason. He wants to better control his phantom limb pain so he can take on a farm management opportunity.
Peter James’ Treatment Goals
Question: Why should Peter James establish treatment goals? Select the correct answer below and then read Peter James’ treatment goals. There may be more than one correct answer.
1. Establishing treatment goals fosters a collaborative relationship with care providers.
2. Establishing treatment goals empowers the patient to help prioritize the treatment plan.
3. Establishing treatment goals offers the opportunity for care providers to address any unrealistic expectations.
4. Establishing treatment goals clarifies the framework for addressing care.
Peter James’ Treatment Goals
- Reducing his pain
- Reduce his dependence on opioids
- Improve his sleep
- Function better overall
Effectiveness of Current Medications
Peter James currently takes opioids to treat his phantom limb pain. He says they don't feel effective.
“The opioids, they help with muscle pains, you know, my lower back and hip, or my other knee that’s trying to support me. But, you know, so, it binds me up. You know, as soon as I start on an opioid, I need the Colace to get through. But it doesn’t seem to touch the phantom pain. It’s not real, right?”
Most Effective Phantom Limb Pain Treatment
Peter James describes his current method of self-treatment for his phantom limb pain.
“I slap it around, you know, rub the stump, hit the bottom to remind my brain that it ends here, and you know, there’s nothing down there. It takes a lot of convincing sometimes.”
Where Peter James Feels the Pain
Peter James says he feels pain, “Mostly around the ankle and foot, but it can be anywhere below the knee.”
Dr. Kent says, “So it is a true phantom. It’s where you used to have the limb.”
Peter James responds, “Right.”
How the Pain Affects Peter James
Peter James says the pain, "Can be very debilitating at times. I know it’s not there. But I can’t think about anything else.”
Peter James' Overall Pain Experience
Peter James describes his overall experience with phantom limb pain.
“Well, it comes and goes; the phantom pains. It seems to go along with weather changes and activity levels. You know, if I’ve really been very active one day, I’ll get more sensations and pains that night when I’m trying to fall asleep.”
Concerns About Prosthetic Fit
Dr. Kent asks Peter James if can examine the residual limb, and Peter James acquiesces.
- Peter James takes Trazadone 100mg qhs for depression and anxiety.
- Peter James takes Zolpidem 10mg PRN for insomnia.
- Peter James takes Oxycodone IR 30mg q3h PRN for pain.
- Peter James takes Alprazolam q8h PRN for anxiety.
- Peter James takes Fluoxetine 40mg/day for depression.