Amputation Pain: Causes, Symptoms & Treatment

As a life-saving measure, amputation is often the last resort. Afterwards, amputation pain is relatively common. There are two types: phantom limb pain and stump pain.

What is amputation pain?

After the surgical removal of a body part, it is called amputation. The result of this life-saving surgical procedure is often amputation pain. After the surgical removal of a body part, it is called an amputation. The consequence of this life-saving surgical intervention is often amputation pain. A distinction is made between phantom pain and stump pain. Medical experts are still puzzling over the cause of phantom pain. The body part, which is effectively no longer present, hurts even though it no longer belongs to the body. Phantom limb pain is the result of more than 50 percent of all amputations. Even if a limb is amputated in an accident, this amputation pain can occur. Some affected persons also still have touch, temperature and movement symptoms in the amputated limb. This is referred to as phantom sensations. Another type of amputation pain is stump pain. Here, the pain occurs directly at the amputation stump. There is chronic and acute residual limb pain.

Causes

The causes of amputation pain vary. Depending on how the pain occurs, it is referred to as phantom limb pain and stump pain. Amputation pain in the limb that is not present is called phantom limb pain. The causes of this have not yet been researched. There are various theories as to how this pain occurs. The severity of amputation pain depends primarily on how long the pain lasted before the amputation and how intense it was. The irritated nerve cells have stored the pain and continue to respond later, even when there is no longer a stimulus. Reduced blood flow in the remaining stump or increased muscle tension are also possible. Psychological factors are also conceivable. Depending on the patient’s condition, amputation pain can vary in intensity. Stump pain often occurs immediately after amputation. This acute amputation pain is a result of wound pain, infection, and bruising. If the stump pain is chronic, it may be caused by circulatory problems, nerve damage, bone spurs, scar pain, Sudeck’s disease, poor prosthetic fitting, and chronic infections, for example.

Symptoms, complaints, and signs

Primarily, amputation pain is associated with very severe pain. These occur mainly in the affected region where a limb is amputated. In most cases, it is also not possible to make a direct prediction about the course of amputation pain. In the worst case, the pain may last for several months and may not disappear on its own. The pain itself often spreads to neighboring regions on the body, so that there is also severe pain in these areas. Especially at night, the amputation pain can lead to insomnia and thus to irritability or depression. In general, permanent pain can also lead to psychological upsets and make the daily life of the affected person much more difficult. Often, this pain can only be limited and alleviated to a certain extent by taking pain medication. In addition to amputation pain, infection or inflammation of the wound can also occur. This is often accompanied by a discharge of pus or redness. The pain also usually intensifies when the affected region is strained or stressed. In general, the patient’s ability to bear weight decreases significantly.

Diagnosis and course

First, the physician tries to determine whether the amputation pain occurs on the non-existing body part or on the stump. The affected person must describe the pain in great detail. It is important to name the duration, intensity, character and triggering factors and whether countermeasures have already been applied. A pain diary can be very helpful for documentation. Even if phantom limb pain is suspected, all causes of limb pain must be ruled out. During a physical examination, the physician examines the surgical residual limb and tries to determine whether inflammation, induration, pain points or circulatory disturbances are present.Magnetic resonance imaging, X-rays, and angiographies may be performed for further diagnosis. The course of amputation pain depends on the cause and the type of pain. Stump pain can be acute or chronic. It often develops immediately after the amputation. Phantom limb pain, on the other hand, is more protracted, may improve on its own, and may suddenly reappear after some time. For all types of amputation pain, early therapy is important for long-lasting success.

Complications

Amputation pain always occurs after an amputation and is completely normal to a certain extent. The affected person must take pain medication for the pain, but this should disappear after a few weeks after the amputation itself. However, it is also possible for the amputation pain to be present for months after the amputation. If this pain is still very severe, be sure to see a doctor. Amputation pain often occurs because an infection or inflammation has developed at the wound. Such infections or inflammations must be treated urgently by a doctor. Serious health problems can occur here if these infections are not removed in time. A pain diary helps the doctor enormously to determine the cause of the pain. Amputation pain also occurs when the limb that has been amputated is subjected to relatively heavy use. Especially in the first months after the amputation, the affected limb must be spared and not physically strained. When stressed, amputation pain occurs and is completely normal. However, they disappear again when the wound is completely healed.

When should you go to the doctor?

Amputation pain is one of the most severe and complex pains in the human body. It occurs immediately after the amputation of a body part or internal organ and is then normal and expected. While the patient is still in the hospital, he or she should talk to the attending physician about the pain if it is not at least tolerable with the pain medications that have been given so far. Surgical pain usually improves within a few days or weeks, becoming weaker and easier to bear. If this is not the case, the doctor should re-examine the surgical wounds and find out why the pain is still so severe. However, with amputation pain, there is a psychological component even months and years after the initial surgical pain. The affected person may feel pain as if the removed body part were still there. The residual limb can also cause severe pain during limb removal. Poorly fitting prostheses create pressure points and scraped skin, which are also counted as amputation pain. In all these cases, the patient should see the doctor promptly, because at the latest when amputation pain occurs due to psychological reasons, it can be assumed that it can no longer be managed without medical help. There is a risk that the patient will uncontrollably take strong painkillers and thus become addicted to them after only a short period of use.

Treatment and therapy

Therapy depends on whether the amputation pain is phantom pain or stump pain. In phantom limb pain, the primary treatment is to address the pain because the cause of the pain is no longer present. Treatment for this amputation pain must be fast and consistent. If the pain persists for more than six months, it is difficult to treat. Medications such as opiates, analgesics, psychotropic drugs, calcitonin and capsaicin are suitable. Similarly, phantom limb pain is treated by neural therapy, mirror therapy, or psychotherapy. Stump pain is treated by eliminating the cause. For example, infections need to be cured and ill-fitting prostheses need to be better fitted. Meanwhile, benign lump formations and undirected nerve neoplasms are not removed.

Outlook and prognosis

In most cases, amputation pain represents a common symptom that usually cannot be avoided. This pain thereby subsides with time, although no general course can be predicted. In some cases, individuals may continue to suffer from pain for months after the amputation.Furthermore, the amputation pain can also be caused by an infection or inflammation, so that it must be treated in any case. The treatment is then carried out with the help of antibiotics, whereby there is usually a positive course of the disease. Likewise, painkillers are also used to limit the amputation pain and to facilitate the daily life of the affected person. The quality of life is significantly reduced by the pain and it is not uncommon for psychological complaints or depression to occur. In this case, psychological treatment of the patient may be necessary to prevent further consequential damage. Most amputation pain can also be limited by fitting prostheses. Not in every case can this pain be limited. The patient’s life expectancy may also be reduced by amputation.

Prevention

Amputation pain can be prevented only to a small degree. The best prevention is to administer pain medication before the amputation. This prevents the nerves from “remembering” the pain before the surgical procedure. Electrical stimulation procedures help prevent amputation pain immediately after the amputation if applied directly to the residual limb. It is also very important that the prosthesis fits very well and that this is checked regularly and readjusted if necessary.

Aftercare

After the amputation of a limb, two different types of pain are known to occur. Both need to be treated as promptly as possible. Amputation pain can be very real pain on the remaining arm or leg stump. This pain may be due to pressure points on the stump or. It can also be pain from wound inflammation. Until the residual limb has healed, follow-up care should not end. It includes fitting a prosthesis and practicing with it. However, problems with amputation pain can always occur later. In some cases, follow-up is necessary again because a severe inflammation or pressure sore in a diabetic patient needs to be treated. Sometimes the follow-up requires a further shortening of the amputation stump by a few centimeters. During follow-up care, the prosthesis must then also be adjusted. Typical amputation pain also includes so-called phantom pain. This involves pain occurring in fits and starts in the limb that is no longer present. Since this amputation pain does not always occur immediately after the amputation and has no real location, it is more difficult to treat. Follow-up care in this case can only be about pain relief and education about the nature of this pain phenomenon. Follow-up care should begin as soon as possible after the amputation, because amputation pain is then easier to resolve.

Here’s what you can do yourself

In the case of amputation pain, a distinction must be made between stump pain and phantom limb pain when it comes to actions the affected person can take to alleviate the same themselves. Since phantom limb pain, strictly speaking, has no physical cause, the brain must also be acted upon in cases of non-drug therapy. It has been shown that the so-called mirror therapy, in which the presence of two healthy limbs is simulated by an appropriate and handy apparatus, brings relief. The brain is tricked by moving and relaxing the healthy part of the body in such a way that the mirror – the representation of the amputated part of the body – has to come into the same position. The brain interprets this as actual relaxation. Phantom limb pain, such as residual limb pain, can also be relieved using electrical stimulation. Massages of the limbs and certain gymnastic exercises can also help. In the case of residual limb pain, the effectiveness of self-imposed measures depends greatly on the cause of the pain. Improperly fitting prostheses and infections cannot be managed alone. Sudden attacks of pain without an identifiable cause can usually be relieved with medication rather than massage or warm baths. In the case of pain conditions, measures for relaxation are generally positive. This may include engaging in a hobby, taking a sauna, or resting in bed for a short time. Consuming herbal substances that have an analgesic effect can also be part of pain therapy.