Prosthetic Categories

Different Types of Post-Amputation Pain

    Most people expect pain after an amputation. However, there are different types of post-amputation pain categorized into two kinds: residual limb pain and phantom limb pain. It’s crucial to differentiate between these types of pain because the treatment and management strategies differ.

     Residual limb pain and phantom limb pain are the two types of post-amputation pain.

    Although phantom limb pain is different from residual limb pain, they often appear together.

    This article discusses the characteristics of the two types of post-amputation pain and how to treat them.

    Residual Limb Pain  

    About half of new amputees may experience residual limb pain or stump pain in the first week after an amputation.

    However, not developing residual limb pain in the first few weeks after amputation doesn’t mean a patient will never experience it. A popular case involves a patient who developed residual limb pain eight years after his amputation. He described the pain as a tingling and burning sensation. Physicians discovered that the pain was caused by a neuroma developing in his sciatic nerve.  

    The patient was treated for delayed residual limb pain using a combination of medicines, injections, and ultrasonography-guided radiofrequency.

    Identifying Residual Limb Pain  

    Residual limb pain varies in severity, but patients typically report uncomfortable sensations such as burning, pressing, stabbing, squeezing, or throbbing.

    Physicians can diagnose residual limb pain using specific tests and procedures. These include:

    Physical exam where the physician checks for bone problems, masses, pressure sores, skin breakdown, and signs of infection. This is when physicians often detect neuromas—nerve-ending tangles that can form after amputation—as well as complications with the fit of a prosthetic limb.

    Imaging tests, such as CT scans, MRI, ultrasound, or X-rays, help rule out other causes of pain and identify bone abnormalities, fractures, infections, and tumors.

    Blood tests detect other medical conditions that could result in pain.

    Treating Residual Limb Pain   

    In about half of the patients, residual limb pain resolves without treatment. But for the other half who need treatment, the focus is on treating the underlying cause of the pain. Relieving pain may require a combination of the following options: medications, such as anticonvulsants, antidepressants, and pain relievers; physical and occupational therapy; neuromodulation; massage; and hypnosis. 

    Recently, researchers found that targeted muscle reinnervation (TMR) surgery works for residual limb pain. It can prevent pain as well as allow prosthetic limbs to read muscle signals.

    Phantom Limb Pain  

    Unlike residual limb pain, the defining characteristic of phantom limb pain is feeling pain from a body part that’s no longer there. Physicians once believed that this phenomenon was a psychological issue. However, research has shown that phantom pain is a real sensation from the brain and the spinal cord.

    Identifying Phantom Limb Pain  

    Phantom limb pain can develop within the first week after an amputation. It can also be delayed by months or years. The pain can also fluctuate or be continuous.

    Those who suffer from phantom pain describe the sensation as burning, cramping, crushing, stabbing, shooting, and throbbing. For most amputees, the phantom pain may be similar to the pain they may have felt in their limbs before amputation.

    There is currently no medical test to diagnose phantom pain. Physicians identify the condition based on the symptoms and the knowledge that a miscommunication between the brain, spinal cord, and nerves could cause it. Physicians will also typically ask their patients about other causes that can worsen phantom pain, including anxiety, depression, stress, and pain in the limb before amputation.

    Treating Phantom Limb Pain  

    For some people, phantom pain gets better over time without treatment. For others, pain management can be challenging. It often requires a holistic approach, which includes the expertise of surgeons, physical therapists, prosthetists, and psychologists.

    Physicians can alleviate phantom limb pain through a combination of treatments: pain relievers, physical and occupational therapy, antidepressants, surgery on the residual limb and nerve, wearing a prosthetic limb frequently, electrical stimulation, mirror box therapy, virtual reality therapy, massage therapy, and TMR.

    The bottom line  

    Pain after an amputation can be categorized into either residual limb pain or phantom limb pain. Determining the type of post-amputation pain is crucial so the health care team can administer the correct treatments.

    But determining the type and causes of pain can be challenging. This is why it’s also essential for patients to be aware of and to describe the pain they experience accurately.