Tests and procedures used to diagnose residual limb pain may include:. 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.
Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. 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.
Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Benzon HT, et al. Phantom limb pain. In: Practical Management of Pain. Philadelphia, Pa. Accessed Sept. Phantom limb sensations are sensations that seem to be coming from the amputated limb. Occasionally, these can be painful phantom limb pain.
Phantom limb pain is a real phenomenon, which has been confirmed using brain imaging scans to study how nerve signals are transmitted to the brain. The symptoms of phantom limb pain can range from mild to severe. Others have described constant severe pain. Stump and phantom limb pain will usually improve over time, but treatments are available to help relieve the symptoms. There are several non-invasive techniques that may help relieve pain in some people. A small study by Jaeger confirmed the benefits of a short treatment course of salmon calcitonin on phantom limb pain the effects of which were still evident on follow-up 1 yr later.
Despite these promising early results, salmon calcitonin has seldom been studied and is infrequently utilized in acute pain management. Due to its good safety profile, low incidence of side-effects, and efficacy it should be considered for early treatment of acute phantom limb pain.
A dose of IU per day given subcutaneously as a treatment course for 5—7 days should be considered for acute presentations. Perineural clonidine has been found to prolong and enhance regional anaesthesia and reduce mechanical hypersensitivity after nerve injury. There are no well conducted studies specifically examining the use of clonidine as an adjuvant to perineural blockade for amputation.
In our practice, perineural clonidine is reserved for patients whose block has not been complete or who are judged to be very high risk of severe stump or phantom pain. Ketamine is the most widely used NMDA antagonist. It has specific anti-neuropathic, anti-nociceptive and anti-hyperalgesic properties. It is commonly used perioperatively for amputation surgery but it does not prevent the development of phantom limb pain.
Rather, Ketamine can decrease the severity of phantom pain experienced. Memantine is another NMDA antagonist that is seldom considered in pain management. It has different binding characteristics at the NMDA receptor compared with Ketamine and, crucially, is relatively free of the psychotropic effects that frequently limit the use of Ketamine.
Memantine has no active metabolites, is renally excreted and preferentially accumulates in the CNS where it has a half-life of 80 h. All these properties are advantageous in treating pain in amputees. Memantine has been studied when given perineurally and orally. The conclusions reached from these studies and in subsequent reviews dismissed Memantine on the grounds of lack of statistical significance in treating phantom pain.
Crucially, Memantine did display considerable clinical significance in these studies and the evidence available needs to be re-evaluated with this in mind.
Local experience indicates Memantine is generally well tolerated and efficacious in the management of phantom pain. Back pain is a very common yet under recognized and seldom studied post-amputation pain problem. Back pain can arise de novo after amputation or pre-exist and be exacerbated by loss of a limb.
Back pain may also occur as a result of prolonged bed rest after surgery but is more frequently encountered during the early rehabilitation phase during weight bearing on a prosthesis. Considerable bio-mechanical changes occur in the lower back and pelvis as a result of altered weight and force distribution and different muscle utilization.
Assessment of the clinical characteristics of back pain is essential to exclude any specific spinal or disc pathology. Following exclusion of spinal pathology, e. Pharmacological management should comprise simple analgesics, anti-inflammatories where clinically appropriate , middle strength opioids, and non-benzodiazepine-based neuromuscular blocking agents.
TENS machines and acupuncture are also useful in this setting. Strong opioids should be avoided if at all possible. Post-amputation pain management remains a challenging area of clinical practice. A wide variety of pain problems present after operation which need careful clinical assessment to differentiate. Despite considerable advances in surgical and anaesthetic practices, pain related morbidity remains high after amputation.
The evidence base for optimal analgesic management is incomplete but it is wrong to use this reason as a basis for persevering with conventional treatment strategies that have proved ineffective. Best evidence, clinical experience, and pragmatism all indicate prolonged perineural blockade is the best analgesic technique post-amputation to attenuate both nociceptive and neuropathic pain.
Continuation of perineural blockade for a minimum of 72 h post-amputation is essential in achieving this goal. A multi-disciplinary, multi-modal approach to pain management must be emphasized comprising assessment and engagement in pain control from all team members involved in the care of amputees.
Early treatment of acute phantom limb pain with novel analgesic agents such as salmon calcitonin and Memantine may offer the best chance of success to prevent chronicity alongside active physical and rehabilitation therapy. Lower Limb Amputation: Working Together. November Phantom pain and sensation among British Veteran Amputees.
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Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Pain following amputation. Stump pain. Management of acute stump pain. Phantom limb pain. Prevention and treatment. Pharmacological treatment. Salmon calcitonin. NMDA antagonists. Back pain. Pain after amputation. Oxford Academic. Select Format Select format. Key points. Table 1 Aetiology of persistent stump pain. Infection Wound breakdown Arterial insufficiency Osteomyelitis Bone spur Haematoma Insufficient myoplasty covering Poorly fitting prosthesis.
Open in new tab. Table 2 Risk factors for developing phantom limb pain. Severe preoperative pain Bilateral amputation Stump pain Repeated limb surgeries Increasing age. Google Scholar Crossref. Search ADS. All rights reserved. For Permissions, please email: journals. Issue Section:. Download all slides.
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