Hayaleti Susturmak - Amputasyon Hastalarında Pregabalin Kötüye Kullanımı: Bir Olgu Sunumu

Yıl 2024, Cilt: 25 Sayı: 4, 498 - 504, 30.12.2024

Mustafa Danışman , Gonca Aşut

https://doi.org/10.51982/bagimli.1458224

Öz

Ampütasyon sonrasında bireyler sadece fiziksel acı değil, aynı zamanda vücut bütünlükleri aniden bozulduğu için psikolojik zorlanmalarla da karşı karşıya kalırlar. Kesilen uzvun hala var olduğu hissi olarak tanımlanan hayalet (fantom) uzuv hissi, amputasyondan sonra yaygın olarak görülür. Hayalet uzuv ağrısı genellikle bu hislere eşlik eder. Fizyolojik uyumun ötesinde, hastaların psikolojik uyum yolculuğu da çok önemlidir. Bu olgu sunumunda, sağ kolu ampute bir hastada hayalet uzuv hissi, psikolojik faktörler ve pregabalin kullanım bozukluğu arasındaki karmaşık ilişki incelenmektedir. 25 yaşında sağ kolu ampute erkek hasta pregabalin bağımlılığı tedavisi almak için Alkol ve Madde Bağımlılığı Tedavi Merkezi (AMATEM) polikliniğine başvurdu. Ergenlik döneminde üzüntüsüyle başa çıkmak için esrar kullanım öyküsü mevcuttu. Esrar kullanımı başlangıçta duygusal rahatlama sağlarken, daha sonra pregabalin kötüye kullanımına dönüşmüştü ve olgu 3000 mg/gün pregabalin kullanmaktaydı. Hayalet uzuv ağrısını tedavi etmek için pregabalin de dahil olmak üzere birçok farmakolojik ajan denenmektedir. Hayalet uzuv ağrısı tedavisindeki olumlu etkilerinin ötesinde, pregabalinin bağımlılık yapıcı özellikleri hakkında son zamanlarda birçok çalışma yayınlanmıştır. Bu vaka, ampüte hastalar için psikolojik destek, erken protez müdahalesi, sosyal ilişkilerin yeniden sağlanması ve uygun farmakolojik tedavi yönetimi dahil olmak üzere kapsamlı bakım ihtiyacının altını çizmektedir. Bu olgu sunumu ampütasyon sonrası dönemin sadece fiziksel bir mücadele değil, aynı zamanda iyileşme ve tatmin edici bir hayata yeniden uyumlanmaya yönelik karmaşık bir psikolojik yolculuk olduğunu hatırlatmaktadır.

Anahtar Kelimeler

Amputasyon, Gabapentinoidler, Hatalı Kullanım, Hayalet Uzuv Ağrısı, Hayalet Uzuv Sendromu, Pregabalin

Proje Numarası

Case Report

Silencing the Phantom - Pregabalin Misuse in Amputation Patients: A Case Report

Öz

In the aftermath of amputation, individuals face not only physical pain but also psychological challenges as their body's integrity is suddenly disrupted. Phantom limb sensations, characterized by the feeling that the amputated limb still exists, are common after amputation. Phantom limb pain often accompanies these sensations. Beyond the physiological aspects, patients' psychological adaptation journey is pivotal. This case report delves into the intricate relationship between phantom limb sensations, psychological factors, and pregabalin use disorder in a right-arm amputee patient. A 25-year-old right-arm amputee male patient went to an addiction outpatient clinic for pregabalin addiction treatment. He had a history of cannabis use to cope with his sadness during his adolescence. While cannabis use initially provided emotional relief, it later turned to pregabalin misuse, escalating to alarming doses (3000mg/day). Many pharmacological agents, including pregabalin, are being tried to treat phantom limb pain. Beyond its positive effects in phantom limb pain treatment, many studies have been published about its addictive features recently. This case underscores the need for comprehensive care for amputees, including psychological support, early prosthetic intervention, social reintegration, and judicious medication management. This case report serves as a reminder that the post-amputation period is not just a physical struggle but also a complex psychological journey toward healing and reintegration into a fulfilling life..

Anahtar Kelimeler

Amputation, Gabapentinoids, Misuse, Phantom Limb Pain, Phantom Limb Syndrome, Pregabalin

Etik Beyan

The authors confirm that they have obtained a patient consent form. The patient understands that names and initials will not be published and that every effort will be made to conceal the identity, but anonymity cannot be guaranteed.

Proje Numarası

Case Report

Kaynakça

• Desmond D, MacLachlan M. Psychosocial issues in the field of prosthetics and orthotics. J Prosthet Orthot 2002; 14(1):19-22.
• Khan MJ, Dogar SF, Masroor U. Family relations, quality of life and post-traumatic stress among amputees and prosthetics. Pakistan Armed Forces Medical Journal 2018; 68(1): 125–130.
• Casale R, Damiani C, Rosati V. Mirror therapy in the rehabilitation of lower-limb amputation: are there any contraindications? Am J Phys Med Rehabil 2009; 88(10): 837-842.
• Weeks SR, Anderson-Barnes VC, Tsao JW. Phantom limb pain: theories and therapies. Neurologist 2010; 16(5): 277-286.
• Flor H. Phantom-limb pain: characteristics, causes, and treatment. Lancet Neurol. 2002; 1(3): 182-189.
• Manchikanti L, Singh V. Managing phantom pain. Pain Physician 2004; 7(3): 365.
• WHO. International Classification of Diseases, Eleventh Revision (ICD-11). Geneva: WHO, 2021.
• Scholz J, Finnerup NB, Attal N, et al. The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. Pain. 2019; 160(1): 53-59.
• Frazier SH, Kolb LC. Psychiatric aspects of pain and the phantom limb. Orthop Clin North Am 1970; 1(2): 481-495.
• Flor H, Elbert T, Mühlnickel W, et al. Cortical reorganization and phantom phenomena in congenital and traumatic upper-extremity amputees. Exp Brain Res 1998; 119(2): 205-212.
• Collins KL, Russell HG, Schumacher PJ, et al. A review of current theories and treatments for phantom limb pain. J Clin Invest 2018; 128(6): 2168-2176.
• Bone M, Critchley P, Buggy DJ. Gabapentin in postamputation phantom limb pain: a randomized, double-blind, placebo-controlled, cross-over study. Reg Anesth Pain Med 2002; 27(5): 481-486.
• Rusy LM, Troshynski TJ, Weisman SJ. Gabapentin in phantom limb pain management in children and young adults: report of seven cases. J Pain Symptom Manage 2001; 21(1): 78-82.
• Richardson C, Kulkarni J. A review of the management of phantom limb pain: challenges and solutions. J Pain Res 2017; 10: 1861-1870.
• Ramachandran VS, Brang D, McGeoch PD. Size reduction using Mirror Visual Feedback (MVF) reduces phantom pain. Neurocase 2009; 15(5): 357-360.
• Chaudhary N, Jain S. Pregabalin addiction: Case report of a young adult. International Healthcare Research Journal 2020; 4(3): 60-63.
• Bicknell M, Rhinds D. Assisted withdrawal of pregabalin in drug and alcohol users. Prescriber 2023; 34(5): 11- 14.
• Richardson JL, Damkier P, Diav‐Citrin O, et al. A critical appraisal of controlled studies investigating malformation risks following pregabalin use in early pregnancy. Br J Clin Pharmacol 2023; 89(2): 630-640.
• Kriikku P, Ojanpera I. Pregabalin and gabapentin in non-opioid poisoning deaths. Forensic Sci Int 2021; 324: 110830.
• Yasmine C, Aicha D. Pregabalin addiction characteristics at oran: A cohort study. Eur Psychiatry 2021; 64(Suppl1): S559.
• Stankevicius A, Wallwork SB, Summers SJ, et al. Prevalence and incidence of phantom limb pain, phantom limb sensations and telescoping in amputees: A systematic rapid review. Eur J Pain 2021; 25(1): 23-38.
• Nejatkermany MPZ, Modirian E, Soroush M, et al. Phantom limb sensation (PLS) and phantom limb pain (PLP) among young landmine amputees. Iran J Child Neurol 2016; 10(3): 42-47.
• Nikolajsen L, Christensen KF. Phantom limb pain. In Nerves and Nerve Injuries (Eds RS Tubbs, E Rizk). New York: Academic Press 2015: 23-34.
• Ali S, Haider SKF. Psychological adjustment to amputation: variations on the bases of sex, age and cause of limb loss. Journal of Ayub Medical College Abbottabad 2017; 29(2): 303-307.
• Roșca AC, Baciu CC, Burtăverde V, Mateizer A. Psychological consequences in patients with amputation of a limb. An interpretative-phenomenological analysis. Front Psychol 2021; 12: 537493.
• Bergo M, Prebianchi H. Emotional aspects present in the lives of amputees: A literature review. Psicologia: Teoria e Prática 2018; 20(1): 47-60.
• Pasquina PF, Bryant PR, Huang ME, et al. Advances in amputee care. Arch Phys Med Rehabil 2006; 87(3): 34-43.
• Stineman MG, Kwong PL, Xie D, et al. Prognostic differences for functional recovery after major lower limb amputation: effects of the timing and type of inpatient rehabilitation services in the Veterans Health Administration. PM R 2010; 2(4): 232-243.
• Rank O. Das Trauma der Geburt und seine Bedeutung für die Psychoanalyse Zurich: Psychosozial-Verlag, 1924.
• Lieberman MA, Yalom ID, Miles MB. Encounter Groups: First Facts. New York: Basic Books,1973.
• Sherman RA, Sherman CJ, Bruno GM. Psychological factors influencing chronic phantom limb pain: an analysis of the literature. Pain 1987; 28(3): 285-295.
• Committee on Substance Abuse. Marijuana: a continuing concern for pediatricians. Pediatrics 1999; 104(4):982-985.
• Kuffler DP. Evolving techniques for reducing phantom limb pain. Exp Biol Med (Maywood) 2023; 248(7): 561-572.
• Alles SR, Cain SM, Snutch TP. Pregabalin as a pain therapeutic: beyond calcium channels. Front Cell Neurosci 2020; 14: 83.
• Issa CJ, Svientek SR, Dehdashtian A, et al. Pathophysiological and neuroplastic changes in postamputation and neuropathic pain: review of the literature. Plast Reconstr Surg Glob Open 2022; 10(9): e4549.
• Hägg S, Jönsson AK, Ahlner J. Current evidence on abuse and misuse of gabapentinoids. Drug Saf 2020; 43(12): 1235-1254.