Managing Amputee Pain

Pain is one of the most common complaints of amputees. Even after surgery would have healed, amputation-related pain is reported in as many of 80% of amputees surveyed. Pain is strongly associated with slow walking speed, difficulty using a prosthesis and lower quality of life.

Two syndromes unique to amputees are residual limb pain (RLP) and phantom limb pain (PLP).

Residual limb pain

Residual limb pain is pain felt by the amputee in the "stump." It can be caused by internal or external factors. The most common external cause is an ill-fitting prosthesis. While internal factors include poor blood flow (ischemia), infection and inflammation, they are more often the result of the body's attempt to repair itself after the surgery.

Most RLP requires treatment by two or more clinical team members. For example, pain at the end of the bone when the amputee walks on the prosthesis can be addressed by the prosthetist re-aligning the socket of the prosthesis, the physical therapist training the amputee in a better gait pattern and/or the physician prescribing medication.

Treating a neurona

If the neuroma is a problem only when the prosthesis is used, the prosthetist may be able to modify the prosthesis to remove direct pressure from the sensitive area. A pain management physician or surgeon may be called upon for precedures such as neuroablation to deaden the nerve, or revision to move the neuroma deeper into the soft tissue for additional protection.

Phantom sensation

A phantom sensation occurs when an individual feels non-painful sensations in the missing body part. An estimated 60 to 85% of amputees will experience painful phantom sensations. PLP can range from mild to very intense, and have been described as burning, crushing, stabbing and the sensation that the limb is in a painful position. PLP is nerogenic, occurring within the central nervous system, but the exact mechanism is not clearly understood.

Studies suggest that PLP is caused by neural adaptation, changes to the structure of the brain as the nervous system adapts to the amputation. Like a neuroma, PLP is best treated by a team of specialists. Treatment typically begins with medication taken by mouth. Patients who experience side effects may be given medications administered with iontophoresis or absorbed through the skin. Increasing sensory input to the residual limb decreases PLP. A TENS unit, a pager-sized electrical stimulator, applies a mild tingling sensation. Compression can be applied by wrapping an Ace bandage or wearing a shrinker (an elasticized sock provided by the prosthetis) and simply by wearing the prosthesis. Very early prosthetic fitting (within one month of amputation) is recommended for arm amputees to control neural adaptation related to PLP.