Residual limb pain

Residual limb pain is a type of pain felt in the part of an arm or leg that’s left after the arm or leg is removed, called amputation. More than half of people who have an amputation get this type of pain. Sometimes called stump pain, it may happen soon after the surgery, often within the first week. But the pain may last after healing.

Residual limb pain is not the same thing as phantom pain. Phantom pain feels like it comes from the part of the arm or leg that’s no longer there after amputation. But many people have both residual limb pain and phantom pain.

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

Residual limb pain symptoms can begin soon after surgery. Or they can start more than two years after the amputation. The type of pain may depend on the cause. People most often feel the pain at the end of the stump. Pain may feel like:

• Prickling.
• Throbbing.
• Burning.
• Squeezing.
• Stabbing.
• Cramping.

In some people, the residual limb may move by itself a little or a lot.

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

• Issues in the bone or the soft tissue, such as sores or bone spurs.
• Infection.
• Poor blood supply to the part of the arm or leg that’s left.
• A tumor.
• A tangle of nerve endings that forms after the arm or leg is removed, called a neuroma.
• Nerve damage.
• Issues with the fit or use of a replacement arm or leg, called a prosthesis.

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

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

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

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

A replacement limb, called a prothesis, that fits well can ease pressure between the residual limb and the prothesis. This can help prevent residual limb pain. Taking good care of the skin that comes into contact with the prothesis also can help prevent residual limb pain.

Some nerve issues, such as diabetic neuropathy, can make it harder to feel pain. If you have these nerve issues, you can take steps to help prevent skin sores and infections. It may help to remove the prothesis several times a day to check for skin issues and take care of them right away.

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

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

• Physical exam. A healthcare professional feels the residual arm or leg to check for issues in the skin or bones. The healthcare professional also looks for signs of infection and lumps.
• Imaging tests. MRI, CT, X-rays or ultrasound can help rule out other causes for the pain or confirm the diagnosis. These tests may show bone breaks or bruises, tumors, infection, or other bone issues.
• Blood tests. Blood tests may help rule out other causes for the pain or confirm the diagnosis.

Treatment for residual limb pain depends on the cause. For some people with residual limb pain, the pain gets better in time without treatment. Treatments for residual limb pain may involve medicines, therapies or procedures.

Medications

• Pain relievers. Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) available without a prescription may help. Some people need stronger, prescription medicines, such as opioids.
• Antidepressants. Tricyclic antidepressants or selective norepinephrine reuptake inhibitors may help with pain that nerve damage causes.
• Anticonvulsants. Gabapentin (Gralise, Neurontin) and pregabalin (Lyrica) may help relieve pain that nerve damage causes. Experts believe these medicines block nerve signals to ease pain.
• N-methyl-D-aspartic acid agonists, also called NMDA agonists. These medicines that you put on the skin, called topical, may include ketamine. They make nerve cells react less to pain. They may ease pain, but the effects don’t last long. They also can cause serious side effects.

Therapies

• Physical and occupational therapy. These therapies involve exercises people do before and after removal of an arm or leg, called amputation. The therapies also include fitting a replacement arm or leg, called a prosthesis, and learning how to use it. Wearing garments that put pressure on the residual arm or leg, called compression garments, also may help.
• Massage. Gentle massaging of the arm or leg sometimes can ease pain.
• Hypnosis. A small study found that three sessions of hypnosis eased residual limb pain.

Surgery or other procedures

• Nerve blocks. These shots, called injections, block or turn off a nerve’s pain signals. They can help ease residual limb pain. 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, on a nerve to relieve residual limb pain. Treatments may include spinal cord stimulation, also called SCS, peripheral nerve stimulation, also called PNS, and transcutaneous electrical nerve stimulation, also called TENS.
• Osseointegration. This newer procedure connects a replacement arm or leg, called a prosthesis, directly to bone. It may help people who have trouble with a standard prosthesis, including residual limb pain. This procedure is not widely available.

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

  RPNI involves putting the nerve endings into tissue from a muscle graft. The graft often comes from the part of the leg or arm that was removed. This procedure is not widely available.