Use of Calcitonin in Recalcitrant Phantom Limb Pain Complicated by Heterotopic Ossification
Bibliographic record
Abstract
A common complication following amputation is phantom sensation, which may include experiencing pain in the phantom limb. This study details the management of phantom limb pain in a 72‐year‐old man, in whom comorbid heterotopic ossification was present. In addition, the authors provide a review of the literature regarding phantom limb pain management, and summarize the current understanding of heterotopic ossification and its possible link to peripheral nerve injury. BACKGROUND: Phantom limb pain (PLP) is a common complication after amputation, affecting up to 80% of the amputee population. However, only 5% to 10% of amputees have severe PLP impacting daily function. The present report details the management of severe, treatment‐resistant PLP in a 72‐year‐old man with a traumatic left transradial amputation and a comorbid complication of heterotopic ossification (HO). OBJECTIVE: To describe a case of PLP with HO and the possible role of calcitonin in the treatment of both conditions. METHODS: A systematic review of the literature regarding the management of PLP. RESULTS: Seventeen articles that directly addressed PLP were identified; 11 were randomized controlled trials. All involved small samples and follow‐up ranged from 6 h to one year, with the majority limited to six weeks. DISCUSSION: In the present case, medication management was limited by side effects, lack of response and the patient’s desire to avoid long‐term medication. Investigations revealed HO, which was suspected to envelop the median nerve in the proximal forearm. After several unsuccessful medication trials, the literature was reviewed in search of common variables between HO formation and persistent PLP. Ultimately, the biochemical effects associated with nerve injury were identified to be a possible factor in both HO and PLP development. Calcitonin’s proposed mechanisms of action may help to manage HO and PLP at multiple stages of disease development and maintenance. In the present case, a four‐week trial of intranasal calcitonin was successful, with pain control lasting at least 18 months. CONCLUSION: The present case report provided a review of the current literature in PLP pharmacological management and the current understanding of the etiology of PLP and HO, as well as how the two may coexist. It also provided an opportunity to discuss the proposed mechanisms of action of calcitonin in the management of PLP and HO.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".