Mr P described an intense, shooting, burning pain within his ankle that had started immediately on tripping. He said the character was the same as his ongoing pain but worse than it had ever been before. He was adamant that the orthopaedic team needed to operate and that he could not be discharged until they had.
His ankle did not appear swollen or acutely injured. He would not tolerate palpation or examination.
After initially taking paracetamol, codeine, morphine and gabapentin, he was now refusing analgesia as he said none of it worked. Because of a previous GI bleed, NSAIDs were contraindicated. He had been on tramadol and morphine until a year ago but his GP had stopped this following an accidental overdose which the patient said was not a problem because they did not help.
He had a history of coronary artery disease, hypertension and alcohol excess. He described his alcohol consumption as the only way he had found to manage his pain.
His team had requested an x-ray and MRI of his ankle which had shown no acute injury and stable appearances. His blood tests showed deranged LFTs but were otherwise unremarkable.
The orthopaedic team felt there was no indication to operate and were struggling to find a way to move forwards.
- Before continuing, consider how you would manage this patient?
