Post-Amputation Pain and Phantom Limb Pain

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What is Post-Amputation Pain?

Post-amputation pain is a poorly understood, yet common, condition that causes significant
disability and can be difficult to treat. Amputation pain occurs in approximately 60 to 70% of
patients, often arising weeks or months after a limb has been removed due to accident, injury, or
disease. (1-2) Pain following an amputation may develop as either residual limb pain, phantom
limb pain, or phantom limb sensation. (3)

• Residual limb pain – pain or discomfort experienced in or at the stump of the amputated limb
• Phantom limb pain – pain or discomfort felt to be coming from the missing limb or body part
• Phantom limb sensation – sensation or perception of movement coming from the missing
limb or body part

Post-amputation pain is a broad “catch-all” term, often used to refer to any of the aforementioned
(without distinction) or even simply the general pain from the trauma of the amputation itself.
The pain is often described as aching, throbbing, shooting, cramping, or burning. Non-painful
sensations may include feelings of numbness, itching, paresthesias, twisting, pressure or even the
perception of involuntary muscle movements in the residual limb at the amputation site. (4)
These sensations may be generalized to the entire missing limb or localized to specific
anatomical regions such as the fingers or toes.

What is Phantom Limb Pain?

Phantom limb pain is a type of post-amputation pain that can occur in any part of the body that
no longer exists. Phantom pain has been described after mastectomy (phantom breast syndrome),
eye removal and even after teeth extraction.
Phantom sensations may be mild at first and decline over time, yet remain to some degree
indefinitely. Occasionally the discomfort will progress to severe pain that includes intermittent
tremors and muscle spasms.

With time the sensation of a phantom body part can fade away. However in 50% of cases,
especially upper limb phantoms, the missing arm seems to get progressively shorter until the
patient is left with a sensation of the phantom hand alone, dangling from the stump. This
symptom change is referred to as telescoping.

What Causes Post-Amputation Pain?

This type of pain is believed to stem from mixed signals that arise from the residual limb or
brain. At the end of the stump, nerve fibers may grow a mass, or neuroma, that sends disordered

signals to the brain. Meanwhile, in the brain, as other functions gradually take over the part of
the brain that had been linked to the limb, painful sensations may arise.

Risk Factors for Developing Post-Amputation Pain

Relative risks are indicated as: Greater risks (top) > lesser risks (bottom)
• Pre-amputation pain
• Traumatic amputation > surgical amputation
• Upper extremities > lower extremities
• Amputation on both sides > amputation on only one side
• Area of limb amputation closer to the body > area of limb amputation farther from the body
• Older > younger e.g. children have lower incidence than adults
• Female sex
• Poor stump condition and stump pains are associated with phantom pain
• Phantom sensations are associated with phantom pain
• May be associated with catastrophizing and certain pain coping-strategies and beliefs

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