Many patients 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 or lasted a long time. Phantom pain is often more severe soon after the amputation, then decreases over time. For many patients, 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 patients experience phantom sensation, which is not painful but feels as though the amputated limb is still there.
The stump may be painful. If it is, patients should first check for signs of infection and skin breakdown, and if these signs are present, they should consult their physician.
If there is no infection or skin breakdown, massaging the stump sometimes relieves the pain. If massaging is ineffective, analgesics can be used. Typically, NSAIDs or acetaminophen is used, but sometimes opioid analgesics are required. If these measures do not relieve the pain or patients require prolonged opioid therapy, consultation with a pain management specialist may be required to supervise treatment, which may include using mechanical devices (eg, a vibrator), ultrasound, and drugs such as antidepressants (eg, nortriptyline, desipramine) and anticonvulsants (eg, 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 patients change their gait or body alignment or causes them to repeat movements. Regularly doing specific stretching and strengthening exercises may help prevent or relieve this type of pain. A physical therapist can help design an appropriate exercise program.
Last full review/revision February 2010 by Erik Schaffer, CP