We avoided phantom pain because our surgeon and other vets were very proactive about pain meds.  We were using Tramadol, Rimadyl and Gabapentin before and after surgery.  

NOT A VET, but ... I would not alter Tramadol dosage of 25 mg as that is an opiate, but it really can be given and is often prescribed for every 8 hours.  So that may be an option.  

But since this appears to be phantom pain , Gabapentin is the most effective and I would follow the second surgeon's advice.  Pofi weighed about 70 pounds and took 300 mg 3x daily and we were told we could go higher and did so later in his final days. This site shows 200 mg up to 3 x daily should be a safe dosage for Schlomo.

And if it were me, that is what I would do.  Rimadyl as precribed, 2 x day.  Gabapentin at 200 mg 3 x a day.  Tramadol you could try to stay with every 12 hours at that dosage (I might try this as Tramadol is probably least effective), but you can also try every eight hours.  But the very first thing I would do is increase Gabapentin dosage and frequency.  It takes about 2 days to really build to the therapeutic level that should provide steady relief.  And stay at that dosage for a while if it is working - maybe 2 weeks and then taper down.  Try every 12 hours at 200 mg and then 100 mg.  Taper down - don't stop suddenly unless there is a reason to do so (bad reaction).  

I don't know why some vets are so blase about phantom pain . I suspect they would be of a different mind if they had to lose a limb.

Best thoughts for Schlomo.

Hi Mascha,

Our dog, Daisy, is also experiencing similar symptoms to phantom limb pain. She will be 2 weeks post op tomorrow (left front leg amputated due to osteosarcoma). She started with yelping episodes on day 3 post op and has continued since. Her episodes generally occur when she is trying to lie down but sometimes when she is getting up. She was taking gabapentin and rimadyl leading up to surgery but that unfortunately did not seem to have any positive effect on her outcome. She came home on gabapentin (200mg 3x day, she is 54 lbs post surgery), rimadyl and a fentanyl patch. We have tried different concoctions of meds with no noticeable difference. We tried removing the patch, adding tramadol, trying valerian root (per our own vet), tried an injection of buprenorphine and then the fentanyl patch again. Nothing has worked for her. We did videotape one of her episodes and emailed it to her surgeon per her request.The surgeon said she has done about 1000 amputations and hasn't experienced this before. Daisy went back in to the vet yesterday and they had her evaluated by the surgeon and neurologist. The surgeon was able to elicit a pain response near her incisional area where she cut the nerves. They applied a lidocaine patch to the area and kept her over night to watch her. They discussed doing a nerve block to see if that might offer relief. We are anxiously waiting to hear back this morning on how she's doing. It is so distressing to see them so uncomfortable! I hope you are able to find relief soon for Scholmo!

Tiffany

Ok, we're back!

Zato got a great report and he has really rallied the last 12 hours, for which I am so grateful.

We didn't discuss the Amantadine since he's doing better, but we did discuss phantom pain .  The vet said ABSOLUTELY that could be the cause of the sudden yelping.  She said it usually passes in a few weeks and that Gabapentin is really good for that. I noticed Zato did not yelp last night, and it's about the third day on his increased dose.  And she also said that there could be some fear to lie down if it is painful and that can make them vocalize, too.  As well as the Tramadol.  It apparently affects dogs mentally more than it does people as far as side effects go.

She said to continue on the Tramadol every 8 hours for another week and then see if he will tolerate going back to twice a day, and to continue the Gaba 3x a day for the next few weeks to give the nerve/phantom pain a chance to settle down.  She checked all of his joints and said the whimpering (which has almost stopped, too) and the funny stance he has sometimes with his butt low are a combination of inflammation/post-surgical pain (nerves trying to reboot)/and learning how to move with 3 legs. She said while he was used to carrying his front leg from the tumor and getting around fine, that leg still had weight that he used to pivot, so now that the leg is gone, he still has to learn and it fatigues his other muscles.  I felt really good after the visit.  She said basically he's where he needs to be at this point in the recovery process.

Oh, and after going on about suture removal, I found out they'll dissolve. 

I hope your visits went as well.

Tracy & Zatoichi