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Pain in the Residual Limb

(Phantom Pain; Phantom Sensation)

By James Baird, CPO

Many people experience phantom pain at some time. The phantom aspect is not the pain, which is real, but the location of the pain—a limb that has been amputated. Phantom pain is more likely if the pain before amputation was severe, lasted a long time, or if the amputation occurred as the result of trauma. Phantom pain is often more severe soon after the amputation, then decreases over time. It may, in fact, lessen or disappear when using the prosthesis. If necessary, drugs and other treatments can relieve phantom pain.

For many people, phantom pain is more common when the prosthesis is not being worn (because the limb and interface have no contact), for example, at night. The risk of having this pain is reduced if a spinal anesthetic and a general anesthetic are used during surgery. Some people experience phantom sensation, which is not painful but feels as though the amputated limb is still there.

The residual limb may be painful. If it is, the person should first check for signs of infection and skin breakdown. If pain is due to infection, the doctor should be consulted. Even if there is no obvious infection, the doctor should be consulted if pain is severe and sudden or if there is fever; these symptoms may indicate an infection also. The area may be cleaned or flushed out with a solution. Dead skin may be removed, and a bandage applied. Antibiotics and sometimes surgery may be needed.

If there is no infection or skin breakdown, massaging the residual limb sometimes relieves the pain. If massaging is ineffective, pain relievers (analgesics) can be taken. Sometimes opioid (narcotic) analgesics are prescribed. If these measures do not relieve the pain or if the person needs to take opioids for a long time, a pain management specialist may be required to supervise treatment. This treatment of pain may include using mechanical devices (such as a vibrator), ultrasound, and drugs. The drugs may include antidepressants (such as nortriptyline or desipramine) and anticonvulsants (such as gabapentin).

Sometimes pain is felt in other limbs or in the hips, spine, shoulders, or neck. This pain may occur because wearing a prosthesis makes people change the way they walk or hold their body (body alignment) or causes them to repeat movements. Regularly doing specific stretching exercises and exercises to strengthen muscles may help prevent or relieve this type of pain. A physical therapist can help design an appropriate exercise program

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* This is the Consumer Version. *