Amputation stump pain is the sensation of pain in a limb following an amputation. This painc can be stump pain, phantom limb pain or a combination of both. Stump pain is usually caused by nerve injury within the amputation stump. Whereas phantom limb pain is a more complex process. These sensations of stump pain and/or phantom limb pain can follow any type of amputation:
Lower extremityUpper extremity
- above knee – upper arm
- below knee – forearm
- toe – finger
Patients describe the pain in different ways. Some say it feels like a sharp or shooting pain, while others describe it as achy, burning or cramping. Over time, phantom limb pain may become more or less severe. This problem often precludes the use of prosthesis or crutches; thereby, significantly affecting one’s quality of life.
It is therefore understandable that patients with amputation stump or phantom limb pain are very motivated to get help. There are a number of treatments offered by various specialists. Unfortunately, the majority of these treatments are focused on treating symptoms, NOT the cause, therefore a long-term solution is seldom found. Unlike other specialties, peripheral nerve surgery treats the anatomical cause of the chronic pain, ensuring best possible chance for the cure.
You should see Dr. Ducic for chronic Amputation Stump or Phantom Limb pain if your symptoms persist:
- After common reasons for prolonged post-operative pain (infection, bleeding, wound dehiscence, and others) were excluded by your initial surgeon and prosthetist
- Despite the medical care prescribed to you by your surgeon or primary care physician
- Despite supportive care, such as activity and work adjustments
- Despite assurance that a trained prosthetist confirmed correct fitting of your prosthesis
- After six months of prescribed medical and conservative care
Patients with chronic amputation stump or phantom limb pain may also report the sensation of pins and needles, burning or numbness. Scars from previous surgery may be hypersensitive or painful. Symptoms may be present at rest, increased with activity, or any combination. The extent of this pain may vary, depending on severity and etiology of injury and the number of nerves involved.
Failure to intervene in timely manner, risks the evolution into more complex presentations with sensitization and remodeling of your central and autonomic nervous systems. These complex syndromes (referred to as RSD or CRPS) make definitive treatment challenging and difficult. As described in Dr. Ducic’s original and pioneering published study, based on patient’s presentation and findings on physical exam, involved sensory nerves should be surgically identified and removed so they do not continue to generate pain and risk the evolution of a more complicated pain syndrome. Thus, peripheral nerve surgery has an important role in treating chronic amputation stump or phantom limb pain. Definitive treatment of the cause of the pain gives patients a chance to eliminate dependence on pain medications and dramatically improve their quality of life.
During surgery for chronic Amputation Stump or Phantom Limb pain:
- You receive anesthesia so you won’t feel any pain during the surgery.
- Unless you had previous stent or bypass, a tourniquet is used to assist with a bloodless dissection
- An incision is made over involved amputation stump area(s) to access and remove damaged painful nerves. In most cases, the nerves involved are mainly sensory nerves, so no motor deficits are result. Finally, skin is closed in anatomical layers.
- Ambulation with crutches is allowed immediately following surgery, while the use of a prosthesis is granted upon confirmation of a healed incision.
- Peripheral nerve surgery for amputation stump or phantom limb pain is usually an outpatient procedure; your dressing will be removed about 5-7 days after surgery, while sutures are removed about three weeks later.
If you are not sure about your eligibility for surgery, and if you are not in the Washington, D.C. area, you can send me your records so I can determine if you are a good candidate for treatment. Visit my patient forms page for a downloadable form.