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Case: A 19-year-old male who was referred to our clinic from orthopedics department with a complaint of PLP has applied to our outpatient clinic, 2 months after a below-the-knee amputation without prior psychiatric history. He described a sensation of shooting pain and itching in his right foot and toe. He initially rated the PLP a 9 on the visual analog scale (VAS) of 0 to 10. His pain was worse in the evenings and sometimes disrupted his sleep. He didn’t suffered from depression as decided clinically, except loss of appetite examination. Although he was very angry with the driver who had crushed him while he was riding motorcycle, and was ruminating about revenge all day. He said that occasionally he couldn’t get calm without self-mutilation. He was started on duloxetine 30 mg/day for his pain, and olanzapine 2,5 mg/day for his self-mutilating behavior. Fifteen days after initial, he scored 4 on VAS, his appetite and sleep was better. Self-mutilation was decreased but he was still suffering from feeling anger almost all day. The treatment has been re-arranged as duloxetine 30mg/day and risperidone 1 mg/day while olanzapine was quitted. A month later, he reported feeling very well and he scored 1 on VAS. However, in the third month, recurrence of PLP was detected because of not taking the drugs because of feeling very well. Due to particular complaint was pain, he was started on only duloxetine and he is uneventful while under the duloxetine treatment since two months.
Discussion: Various therapeutic approaches have been used in the treatment for PLP and TCAs have been used with some success. The serotonin-norepinephrine reuptake inhibitors (SNRIs) are popular for neuropathic pain, migraines, and fibromyalgia due to fewer side effects and efficacy. In literature there are case reports of successful use with milnacipran and mirtazapine in PLP. Additionally there is a case report of duloxetine and pregabalin combination. This is the first report of duloxetine being successfully used as monotherapy in PLP. We propose that duloxetine could have beneficial effects in treating