Tramadol Plus Pregabalin Combined with Cilostazol as Treatment for Severe Pain in A Filipino Patient with Critical Limb Ischemia secondary to Microscopic Polyangitis a Case Report
Abstract:
Critical limb ischemia is a resting limb pain secondary to poor vascular flow. It has a wide range of differential diagnosis with several proposed medical or surgical treatment strategies. Despite the multiple approach developed, pain management has been individualized due to the challenge encountered in its control. This study describes the successful use of Tramadol in conjunction with Paracetamol, Pregabalin and Cilostazol as pain regimen in a med ically treated patient presenting with severe lower limb pain from a non-healing wound secondary to critical limb ischemia. We report a case of a 28-year old female, non-hypertensive and non-diabetic with a 19 months history of progressive right lower extremity neuropathic and nociceptive pain with associated weakness. Multiple work-up and treatments were done where initial assessment was polyarteritis nodosa r/o Takayasu Arteritis. Patient was treated with the combination of Pregabalin Prednisone, Azathioprine, Aspirin, Colchicine, Ketoanalogues + Amino Acids, Sodium Bicarbonate, Tramadol+ Paracetamol. Despite treatment there was progression of pain hence admission where she was put on multidisciplinary care. In patient work-up was done and patient was eventually assessed to have Critical limb ischemia secondary to Microscopic polyangiitis; Chronic kidney disease Stage 3B sec to glomerulonephritis. Pain was progressive in nature and was controlled using PCA Tramadol with the following settings: Concentration of 10mg/90mL, Basal rate of 7.5mg/hour, Bolus rate of 5mg/demand. Lock out interval of 30 minutes. Adjunctive pain medications included Paracetamol, Pregabalin and Cilostazol. As the patient responded with her immunosup pressants and cardiovascular medications, pain medications were then subsequently titrated down and was eventu ally shifted back orally to Pregabalin 75mg OD and Tramadol + Paracetamol 37.5/325mg/tab 1 tab every 6 hours, with rescue doses of Tramadol + Paracetamol 18.75 +185mg 1 tablet every 4 hours as needed for pain >/= 4/10.
