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Managing Residual Limb and Phantom PainINITIAL PAIN: All individuals undergoing amputation will experience initial pain in the residual limb.

This pain will most often diminish with healing time and with the initiation of limb massage, exercise, and socket fitting.

PHANTOM SENSATION: Nearly all individuals undergoing amputation will experience phantom sensation, or the feeling that the absent limb is still there. This is not necessarily painful, but rather the sensation of an itch or the twitching of the toes, etc. Some phantom sensation will usually be present for life, but will substantially decrease with healing and prosthetic use.

PHANTOM PAIN: Far less consistently, phantom pain will be experienced. Often this is described as a piercing or twisting sensation in the area of the absent foot. It is reported that the higher the level of amputation or the more painful the trauma to the lower limb prior to the amputation, the greater the tendency to have phantom pain.

THE CAUSE OF PHANTOM PAIN is not fully understood.

There is not one treatment that works for everyone; however, the vast majority of individuals undergoing amputation find that phantom pain is greatly reduced when functional walking with a prosthesis is mastered. This does not mean pain is completely abolished, but it becomes progressively less frequent and more short-lived, often only seconds long and weeks to months apart.

Let us look at one widely accepted theory of the cause of phantom pain to help in understanding how some treatments can reduce symptoms. We know that a great deal of damage has occurred to the neurologic system within the limb, causing an increase in excitatory or painful messages sent up to the brain.

At the same time, a degree of the inhibitory or non-painful messages that are generated from the surface area of the limb or skin have been eliminated with the amputation of the limb.

To understand this more simply, consider being hit in the arm. The first thing you do is grab your arm or rub it over a broad area which causes inhibitory messages to be generated from the skin and diminishes the preception of excitatory or painful messages coming from the irritated internal nerves. This process explains why many of the self-treatment options given on the attached sheet can work.

SELF-TREATMENT SUGGESTIONS for RESIDUAL LIMB and PHANTOM PAIN

  • Start gently and progressively massage the residual limb with both hands. May also tap the limb or squeeze gently over most sensitive areas.
  • Ace wrap, apply a shrinker or rigid dressing to the limb.
  • Slowly tighten and release muscles within the residual limb.
  • Mentally exercise the muscles in the phantom limb where it is painful.
  • Complete the dynamic residual limb exercises given to you.
  • Change your position. Either shift position in chair or stand up to improve circulation.
  • Do general exercise to mildly increase heart rate.
  • Soak in a warm bath or use shower massage on residual limb if incision line is closed. Check the temperature with your hand and use warm - not hot - water. Increased swelling may be a negative side-effect.
  • Wrap the residual limb in a warm soft towel.
  • Mentally relax the phantom limb and your residual limb.
  • Keep a diary of when pain is most severe. Relationships have been reported between certain activities during the day, stresses, even some foods and increased symptoms.
  • If you have your prosthesis, then put it on and take a walk.
  • If the prosthesis is causing increased symptoms, try reducing or adding a sock to improve the fit. If symptoms persist, then contact your prosthetist for necessary adjustments.

YOU SHOULD...

You should consult with your health care provider regarding all treatments used. If self-treatments are not sufficiently successful, then other medical treatments can be offered, such as:

  • Transcutaneous Electrical Nerve Stimulation(TENS)
  • Biofeedback
  • Neural Tension Therapy
  • Specific nerve pain medications
  • Injections
  • Acupuncture
  • Hypnosis
  • Surgical intervention

There are also specialty pain centers throughout the country that can be helpful in chronic cases. HOWEVER, the vast majority of individuals with amputations report pain lessens and becomes more infrequent over time.

Managing Residual Limb and Phantom Pain

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