Amputation Pain and Phantom Limb Pain

What is the condition?
Pain following amputation in the arms or legs is unfortunately very common and affects up to 50% of patients who undergo such amputations.  Pain following amputation can be caused by many factors, but much of it is related to the development of neuromas (painful nerve endings) stemming from the trauma or surgery.  This can manifest as phantom limb sensations, phantom limb pain or generalized pain in the extremity.  At times, this pain can be so intense that it prevents individuals from wearing a prosthetic, which can significantly limit function. 

How is amputation pain and phantom limb pain diagnosed?

The diagnostic workup of post-amputation pain often involves a local anesthetic injection to determine the cause of the pain and whether it is neuropathic (nerve related).  Post-amputation neuromas are treated in the same way as other traumatic neuromas, which involve neuroma excision and a multidisciplinary approach to treatment.

How is amputation pain and phantom limb pain treated?

Another promising intervention for the treatment of post-amputation nerve pain is targeted muscle reinnervation (TMR), which is a surgical procedure in which free nerve endings are directed into adjacent muscle to prevent the development of painful nerve endings.  Early data for TMR is very promising for the improvement of post-amputation pain.