Phantom organ pain syndrome, a ghostly visitor to the ED

作者：Roldan Carlos J^*; Lesnick Joseph S

来源：American Journal of Emergency Medicine, 2014, 32(9): 1152.e1.

DOI：10.1016/j.ajem.2014.02.020

Phantom organ pain syndrome is a phenomenon affecting individuals who have had an organ surgically removed. It occurs presumably as deafferentation due to surgical trauma to the incision site compromising deep somatic nerves and visceral sensory nerves innervating the missing organ. Although countless patients have had organs removed and an innumerable amount of patients have subsequently experienced pain, we are only able to find a handful of cases of phantom organ pain syndrome described in the literature. %26lt;br%26gt;We report a case of a young male who visited our emergency department (ED) with chronic left flank pain despite ongoing therapy with hydrocodone. He had history of chronic pyelonephritis and staghorn calculus. He had a left-sided nephrectomy due to nearly fatal emphysematous pyelonephritis. The pain was described as %26quot;the same%26quot; as that he had experienced for years during pyelonephritis exacerbations. His numerous visits to primary care, specialty clinics, and other EDs to obtain pain killers had already triggered an alert by the Controlled Substances Prescription Monitoring Program as a potential drug diverter. He had extensive postsurgical workup including negative results from magnetic resonance imaging, computed tomography of the abdomen and pelvis with and without contrast, ultrasound, and abdominal x-rays. Despite a concern about drug-seeking behavior, there was no evidence of aberrant behavior or drug diversion. With a gabapentin trial initiated in the ED and subsequent supportive psychotherapy offered in a pain medicine service clinic, his pain was successfully controlled with no opiates. Currently, he is on maintenance doses of gabapentin.

• 出版日期2014-9