Introduction
What is residual limb pain (RLP)? This is pain that originates in the remaining part of your limb. It can be caused by a variety of conditions related to your surgery or it can be caused by conditions you had before your amputation. You and your healthcare team will want to work together carefully to understand the source and cause of your pain so you can treat it successfully.
Normal postoperative pain
After surgery, your postoperative pain will decrease during the first few weeks. After you are discharged from the hospital, you may still be taking pain relievers, but you should be able to taper off the pills fairly quickly. Methods to reduce swelling will also help reduce pain, including elastic bandages and socks for the residual limb, light massage and finger tapping, and cold compresses.
Residual limb pain is different from this normal postoperative pain. For example, it usually occurs after postoperative pain has disappeared. It is often described as sharp, painful, stabbing, or burning in nature. Your entire healthcare team, including your doctors, therapists, and prosthetists, will work with you to determine the cause of this pain and decide which treatments might be most effective.
Possible causes of residual limb pain include:
- Underlying disease process, such as skin problems and infection and nerve pain (neuropathy), especially if you have diabetes or circulatory problems.
- Surgical trauma, including decreased blood supply to the limb or poor tissue coverage at the end of the bone.
- Neuroma formation
- Nerve entrapment in scar tissue.
Underlying disease processes
The key to managing pain symptoms that have to do with a pre-existing condition like diabetes is to make sure the condition is controlled as best as possible.
For example, if you have diabetes, keep your blood sugar level under good control. If you have poor circulation, follow your doctor’s instructions regarding diet, exercise, and medications.
Managing pre-existing conditions after surgery is more important than ever.
Surgical Trauma
Poor tissue coverage may be because the bone at the end of the stump is not trimmed properly at the time of surgery, and this can cause pain when wearing the prosthesis. If padding and other methods are not successful, surgery may be necessary to revise your residual limb to decrease pain and allow you to use your prosthesis.
Neuromas
A neuroma is a group or cluster of nerve endings that forms under the skin of the stump. Think of it as a tangle of hair. It can become very sensitive, especially if the tangle presses against the prosthesis.
Because neuromas are made up of nerve endings, possible treatments include medications that help with nerve pain, such as:
- Non-steroidal anti-inflammatory drugs
- Specific antidepressants and anticonvulsants that have been shown to be effective for
- neuralgia
- Steroid injections.
Drug-free options include:
- Ultrasound, which is essentially a machine that uses sound waves to generate heat within a part of the body. It can help increase blood flow in order to reduce inflammation and swelling.
- Massage, which also helps reduce inflammation and also helps desensitize the stump to touch.
- Vibration, which creates a gentle shock to contract muscles and reduce inflammation and pain.
- Finger percussion/tapping on the pain point, which also helps desensitize the stump
- Acupuncture, manipulation of thin, solid needles inserted into specific pressure points on the skin, which has been helpful for some
- TENS (transcutaneous electrical nerve stimulation), which produces a mild tingling sensation, canceling out some of the pain your body produces.
It may also be useful to modify the fit of the prosthesis to avoid rubbing on the sensitive part of the limb.
Unfortunately, surgery to remove neuromas is usually not successful because they often simply reform.
Heterotopic bone
Occasionally, excess bone forms abnormally around the end of the amputated limb; This is sometimes called a “bone spur.” “Extra” bone can cause pressure points that interfere with the fit of your denture; This occurs more frequently in children than in adults. If the problem cannot be solved with changes to the prosthesis, surgery can remove the excess bone. For children, this is best done after the bone stops growing.
Nerve entrapment in scar tissue
As your incision begins to heal, your doctor will let you know when you can begin massaging your residual limb. This will help prevent the nerves from becoming “trapped” in scar tissue. You will also be taught how to wrap your limb with elastic bandages. This not only helps prevent scarring but also helps with the fit of the prosthesis.
Managing pain
Regardless of the cause of your stump pain, there are some principles that can be followed to help you manage the pain.
- Start exercises as soon as your surgeon allows. Standing, walking, and stretching your muscles not only improve your overall health, but also interrupt pain signals.
- Desensitize your residual limb, following the instructions of your physical or occupational therapist; this includes massaging and wrapping the stump.
- Keep a pain diary. Tracking your symptoms and sharing them with your healthcare team will help you find the right treatments for you.
- Practice relaxation. We know that tension and stress increase pain. It is estimated that 50 percent of pain can be reduced through relaxation.
About the Amputee Coalition
The Amputee Coalition is a nonprofit, donor-supported, voluntary health organization serving more than 5.6 million people with limb loss or difference in the United States.
For more information, call 888-267-5669 or visit amputee-coalition.org.
Expressions of gratitude
This project was supported, in part, by grant number 90LLRC0001-01-00, from the Administration for Community Living, U.S. Department of Health and Human Services, Washington, DC 20201. Grantees undertaking projects under government sponsorship are encouraged to freely express their findings and conclusions. Therefore, the views or opinions do not necessarily represent the official policy of the Administration for Community Living.
