Description

Pain in the residual limb is a type of pain that is felt in the part of the arm or leg that remains after the arm or the leg, called the amputation. More than half of the people who have suffered an amputation to obtain this type of pain. Sometimes called residual limb pain, can occur soon after surgery, often within the first week. But the pain can last after the healing.

Residual limb pain is not the same thing as the phantom pain. The phantom pain feels like it's coming from the part of the arm or leg that no longer exists after the amputation. But many people have pain in the residual limb and phantom pain.

Residual limb pain gets better on its own for some people. For others, there are other treatments.

Symptoms

Pain in the residual limb symptoms may start soon after the surgery. Or you can start more than two years after the amputation. The type of pain may depend on the cause. Often, people feel the pain in the end of the stump. The pain may feel like:

  • The prickle on the skin.
  • Throbbing.
  • Burning.
  • Tighten.
  • Stabbing.
  • The cramps.

In some people, the stump can move by itself a little or a lot.

Causes

There are several causes of pain after removal of an arm or a leg, called the amputation. These include the following:

  • Problems in the bone or soft tissues, such as ulcers, or bone spurs.
  • Infection.
  • Poor blood supply to the part of the arm or left leg.
  • A tumor.
  • A tangle of nerve endings, which form after the arm or the leg, called a neuroma.
  • Damage to the nerves.
  • Problems with the fit or the use of a replacement of the arm or leg, called a prosthesis.

Risk factors

Some studies have found that the risk factors for residual limb pain may include:

  • How high in the body, the arm or the leg was removed, called amputation.
  • How much pain before the amputation.
  • The reason for the amputation.
  • The age at the time of the amputation.

The emotional stress, such as fear and lack of emotional support, it may make the pain worse.

Complications

Residual limb pain affects the quality of life and may get in the way of use a replacement of the arm or leg, called a prosthesis. People with pain in the residual limb may be more likely to be depressed or anxious than people who don't have the pain.

Prevention

A replacement of the limb, called a prosthesis, that is well-suited can relieve the pressure between the residual limb and the prosthesis. This can help prevent pain in the residual limb. Take good care of the skin that comes in contact with the prosthesis can also help prevent pain in the residual limb.

Some nerve issues, such as diabetic neuropathy, can make it difficult to feel pain. If you have these nerve problems, you can take steps to help prevent skin sores and infections. You can help to remove the prosthesis several times a day to check for problems of the skin and take care of them immediately.

Researchers are studying other ways to prevent the pain in the residual limb after amputation.

Diagnosis

To diagnose the pain in the residual limb, a health professional looking for the cause. Some of the causes can be treated. Tests and procedures used to diagnose pain in the residual limb may include:

  • Physical exam. A health care professional feels the residual of the arm or leg to see if there are problems in the skin or bones. The healthcare provider also looks for signs of infection and the appearance of lumps.
  • Imaging tests. Magnetic resonance imaging, computed tomography, X-ray or ultrasound may help to rule out other causes for the pain or confirm the diagnosis. These tests can show bone breaks or bruises, tumors, infection, or other bone problems.
  • Blood tests. Blood tests may help rule out other causes for the pain or confirm the diagnosis.

Treatment

Treatment for residual limb pain depends on the cause. For some people with pain in the residual limb, the pain passes in time without treatment. The treatments for the pain in the residual limb may involve medications, therapies, or procedures.

Drugs

  • Pain relievers. Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) are available without a prescription can help. Some people need stronger, prescription drugs, such as opioids.
  • Antidepressants. Tricyclic antidepressants or inhibitors of the reuptake of norepinephrine can help with the pain that the nerve damage causes.
  • Anticonvulsants. Gabapentin (Gralise, Neurontin) and pregabalin (Lyrica) can help relieve the pain that the nerve damage causes. Experts believe that these drugs block the nerve signals for pain relief.
  • N-methyl-D-aspartic acid agonists, also called agonists of NMDA receptors. These medications are applied on the skin, called a topic, you can include the ketamine. Make the nerve cells react with less pain. You can ease the pain, but the effects do not last for a long time. It can also cause serious side effects.

Therapies

  • Physical and occupational therapy. These therapies involve exercises people do before and after the removal of an arm or a leg, called the amputation. The therapies also include the placement of a substitution of the arm or leg, called a prosthesis, and learn how to use it. Wearing clothes that put pressure on the residual of the arm or leg, called compression garments can also help.
  • The massage. Massage gently into the arm or leg, sometimes, you can relieve the pain.
  • Hypnosis. A small study found that three sessions of hypnosis alleviated pain in the residual limb.

Surgery or other procedures

  • The nerve blocks. These vaccines, called shots, block or disable a nerve pain signals. They can help relieve pain in the residual limb. And, if the block works, it may help diagnose a tangle of nerve endings, called a neuroma.
  • Neuromodulation. These treatments use electrical impulses, called stimulation of a nerve to relieve pain in the residual limb. Treatments may include spinal cord stimulation, also called SCS, the stimulation of the peripheral nerve, also called the peripheral nervous system, and transcutaneous electrical nerve stimulation, also called TENS.
  • The osseointegration. This new procedure connects a replacement of the arm or leg, called a prosthesis, directly to the bones. It can help people who have problems with a standard prosthesis, including pain in the residual limb. This procedure is not widely available.
  • Regenerative peripheral nerve interface.Also called RPNI, this new procedure helps prevent the neuroma, a tangle of nerve endings, which often form after an amputation. It also helps prevent the pain from neuromas that have been formed. Neuromas are a major cause of pain in the residual limb. RPNI involves the placement of the nerve endings in the muscle tissue of the graft. The graft often comes from the part of the leg or arm, which was removed. This procedure is not widely available.

Regenerative peripheral nerve interface. Also called RPNI, this new procedure helps prevent the neuroma, a tangle of nerve endings, which often form after an amputation. It also helps prevent the pain from neuromas that have been formed. Neuromas are a major cause of pain in the residual limb.

RPNI involves the placement of the nerve endings in the muscle tissue of the graft. The graft often comes from the part of the leg or arm, which was removed. This procedure is not widely available.

Symptoms and treatment of pain in the Residual limb