Residual limb pain

Residual limb pain, sometimes called stump pain, is a type of pain felt in the part of a limb that remains after an amputation. It occurs in about half of people who have had an amputation. It may occur soon after the surgery, often within the first week, but may also last beyond healing. Residual limb pain usually isn't severe, but it may feel:

• Pressing
• Throbbing
• Burning
• Squeezing
• Stabbing

In some people, the residual limb may move uncontrollably in small or significant ways. Residual limb pain is different from phantom pain, which is pain that seems to come from an amputated limb. But residual limb pain and phantom pain often occur together. Research shows that more than half of people with phantom pain also have residual limb pain.

Residual limb pain may be caused by:

• Problems in the bone or the soft tissue
• Infection
• Poor blood supply to the limb
• A tumor
• Problems with the fit or use of a prosthesis

It's important to get an accurate diagnosis and identify the cause of your residual limb pain, as some causes may be reversible. Tests and procedures used to diagnose residual limb pain may include:

• Physical exam. Your doctor will likely inspect your residual limb and feel it to check for skin breakdown, pressure sores and problems with the bone. He or she will also look for signs of infection and masses. Your doctor may also tap on your residual limb to check for symptoms of pain that indicate a tangle of nerve endings that can form after amputation (neuroma).
• Imaging tests. MRI, CT scan, X-rays or ultrasound may be used to help rule out other possible causes for your pain or to confirm your doctor's suspicions. These tests may identify fractures, bone bruises and other bone abnormalities, tumors, and infection.
• Blood tests. You may need some blood tests to help rule out other possible causes for your pain or to confirm your doctor's suspicions.

Treatment for residual limb pain focuses on treating the underlying cause of the pain, if possible. In about half of people with residual limb pain, the pain eventually improves without treatment. Treatment options for residual limb pain may involve medications, including

• Pain relievers. Acetaminophen (Tylenol, others) and nonsteroidal anti-inflammatory drugs may help. Stronger medications, such as opioids, may be needed. These may be most helpful for pain resulting from problems with the skin, soft tissues, muscles and bones.
• Antidepressants. Tricyclic antidepressants or selective norepinephrine reuptake inhibitors may help with pain caused by damage to the nerve fibers.
• Anticonvulsants. Gabapentin (Gralise, Neurontin) and pregabalin (Lyrica) may help relieve pain caused by damage to the nerve fibers. It's thought that these drugs interfere with the transmission of nerve signals to reduce pain.
• N-methyl-D-aspartic acid (NMDA) agonists. These drugs, including ketamine, block events that increase sensitivity in the neurons. They're usually given as topical medications applied to your skin. While they're very effective in reducing pain, the benefits don't last very long. They can also cause significant side effects.

Other treatment options include:

• Physical and occupational therapy. These therapies involve exercises done before and after amputation, as well as proper fitting and use of your prosthesis. Wearing compression garments on the residual limb may also help.
• Massage. Gentle massaging of the limb can sometimes reduce pain.
• Hypnosis. A small study found that three sessions of hypnosis reduced residual limb pain in people with the condition.
• Nerve blocks. These injections block or turn off a nerve's pain signals. They can help reduce residual limb pain and may help to diagnose a neuroma if the block stops the pain.
• Neuromodulation. These treatments use electrical stimulation on a nerve to relieve pain. Spinal cord stimulation (SCS), peripheral nerve stimulation (PNS) and transcutaneous electrical nerve stimulation (TENS) are some of the therapies that may be used to help relieve residual limb pain.