Materiały źródłowe

• #1 Residual limb pain – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/residual-limb-pain/symptoms-causes/syc-20541403

  Residual limb pain is a type of pain felt in the part of an arm or leg that’s left after the arm or leg is removed, called amputation. More than half of people who have an amputation get this type of pain. Sometimes called stump pain, it may happen soon after the surgery, often within the first week. But the pain may last after healing. […] Residual limb pain symptoms can begin soon after surgery. Or they can start more than two years after the amputation. The type of pain may depend on the cause. People most often feel the pain at the end of the stump. Pain may feel like: Prickling. Throbbing. Burning. Squeezing. Stabbing. Cramping. […] There are several causes of pain after removal of an arm or leg, called amputation. They include the following: Issues in the bone or the soft tissue, such as sores or bone spurs. Infection. Poor blood supply to the part of the arm or leg that’s left. A tumor. A tangle of nerve endings that forms after the arm or leg is removed, called a neuroma. Nerve damage. Issues with the fit or use of a replacement arm or leg, called a prosthesis.

• #2 Residual limb pain | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/residual-limb-pain?content_id=CON-20442786

  Residual limb pain is a type of pain felt in the part of an arm or leg that’s left after the arm or leg is removed, called amputation. More than half of people who have an amputation get this type of pain. […] To diagnose residual limb pain, a healthcare professional looks for the cause. Some causes can be treated. Tests and procedures used to diagnose residual limb pain may include: Physical exam. A healthcare professional feels the residual arm or leg to check for issues in the skin or bones. The healthcare professional also looks for signs of infection and lumps. Imaging tests. MRI, CT, X-rays or ultrasound can help rule out other causes for the pain or confirm the diagnosis. These tests may show bone breaks or bruises, tumors, infection, or other bone issues. Blood tests. Blood tests may help rule out other causes for the pain or confirm the diagnosis.

• #3 Phantom Limb Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448188/

  Phantom limb pain is the perception of pain or discomfort in a limb that is no longer there. […] The condition should be differentiated from other related clinical conditions such as residual limb pain, which was formerly called „stump pain” and is pain that originates from the actual site of the amputated limb that tends to resolve with wound healing. […] Pain after amputation of a limb is a common symptom and is separated into two types of pain including residual limb pain (RLP) and phantom limb pain (PLP). […] This latter condition, formerly known as „stump pain”, is pain that originates from the actual site of the amputated limb. […] Unlike PLP, RLP is often a manifestation of an underlying source, such as nerve entrapment, neuroma formation, surgical trauma, ischemia, skin breakdown, or infection.

• #4 Phantom Limb Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448188/

  It is important to know the difference between the two because the causes and treatments for each differ, but also be aware that both of these elements can coexist at the same time. […] The goal of the physical exam is to rule out the causes of RLP. […] In terms of pain intensity, RLP usually is not severe, and features pressing, throbbing, burning, squeezing, and stabbing sensations. […] The diagnosis of PLP pain is primarily a diagnosis of exclusion and heavily dependent on the patient’s history. […] Because of this lab tests are often not needed. […] Treatment for RLP tends to focus on an organic cause for the pain, PLP focuses on symptomatic control. […] There is no one treatment that works reliably or consistently in all patients. […] Most patients are prescribed multiple agents to control pain, but tragically, this polypharmacy also has serious adverse effects that tend to lower compliance.

• #5 Residual Limb Pain – Special Subjects – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/special-subjects/limb-prosthetics/residual-limb-pain

  After an amputation, about 60% of people have pain in the residual limb, which can severely limit function, impair quality of life, and significantly impede rehabilitation. Residual limb pain should be evaluated and treated aggressively, because some causes can be dangerous. […] Persistent residual limb pain is a chronic condition that differs from phantom limb pain and phantom limb sensation. […] A person with residual limb pain should first check for signs of infection and skin breakdown. If infection looks likely, the doctor should be consulted. Even if there is no obvious signs of infection, the doctor should be consulted if pain is severe and sudden or if there is fever; these symptoms may indicate an infection. […] Surgical wound pain typically resolves as tissues heal, usually over 3 to 6 months. Pain continuing beyond that time has numerous causes, including infection and a poorly fitting preparatory prosthesis.

• #6 Phantom Limb Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448188/

  It is important to know the difference between the two because the causes and treatments for each differ, but also be aware that both of these elements can coexist at the same time. […] The goal of the physical exam is to rule out the causes of RLP. […] In terms of pain intensity, RLP usually is not severe, and features pressing, throbbing, burning, squeezing, and stabbing sensations. […] The diagnosis of PLP pain is primarily a diagnosis of exclusion and heavily dependent on the patient’s history. […] Because of this lab tests are often not needed. […] Treatment for RLP tends to focus on an organic cause for the pain, PLP focuses on symptomatic control. […] There is no one treatment that works reliably or consistently in all patients. […] Most patients are prescribed multiple agents to control pain, but tragically, this polypharmacy also has serious adverse effects that tend to lower compliance.

• #7

  https://scholars.duke.edu/individual/pub747559

  Residual limb pain is not a diagnosis: a proposed algorithm to classify postamputation pain. […] The term „Residual Limb Pain” fails to distinguish between distinct diagnostic entities such as neuroma, complex regional pain syndrome, and somatic pathology. […] Of the 151 papers reviewed, none further categorized RLP into more specific diagnostic criteria. […] The reported variation in the incidence of PAP phenomena may well represent inconsistency in assessment tools and diagnostic categories rather than variation in prevalence of these conditions.

• #8

  https://journals.lww.com/clinicalpain/Fulltext/2013/06000/Residual_Limb_Pain_Is_Not_a_Diagnosis__A_Proposed.12.aspx?generateEpub=Article%7Cclinicalpain:2013:06000:00012%7C%7C

  Residual Limb Pain fails to distinguish between distinct diagnostic entities such as neuroma, complex regional pain syndrome, and somatic pathology. […] Of the 151 papers reviewed, none further categorized RLP into more specific diagnostic criteria. […] The reported variation in the incidence of PAP phenomena may well represent inconsistency in assessment tools and diagnostic categories rather than variation in prevalence of these conditions.

• #9 Residual limb pain | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/residual-limb-pain?content_id=CON-20442786

  Residual limb pain is a type of pain felt in the part of an arm or leg that’s left after the arm or leg is removed, called amputation. More than half of people who have an amputation get this type of pain. […] To diagnose residual limb pain, a healthcare professional looks for the cause. Some causes can be treated. Tests and procedures used to diagnose residual limb pain may include: Physical exam. A healthcare professional feels the residual arm or leg to check for issues in the skin or bones. The healthcare professional also looks for signs of infection and lumps. Imaging tests. MRI, CT, X-rays or ultrasound can help rule out other causes for the pain or confirm the diagnosis. These tests may show bone breaks or bruises, tumors, infection, or other bone issues. Blood tests. Blood tests may help rule out other causes for the pain or confirm the diagnosis.

• #10

  https://www.painscale.com/article/diagnosing-phantom-limb-pain

  Many people who have had an amputation feel pain, or other sensations, in the limb as if it is still attached. […] A physician should be able to identify phantom limb pain based on current symptoms and the circumstances that caused the limb removal. For proper treatment, it is imperative that the physician determines if the pain is a result of phantom limb pain or residual limb pain. […] A detailed description of the location and severity of the pain is needed by the physician to make a diagnosis. […] No specific medical tests exist to diagnose phantom limb pain. Certain tests such as MRIs or CAT scans may be ordered to determine if the part of the brain that handles pain sensitivity for the amputated limb is showing pain activity.

• #11 Residual limb pain | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/residual-limb-pain

  Residual limb pain is a type of pain felt in the part of an arm or leg that’s left after the arm or leg is removed, called amputation. […] To diagnose residual limb pain, a healthcare professional looks for the cause. Some causes can be treated. Tests and procedures used to diagnose residual limb pain may include: […] Physical exam. A healthcare professional feels the residual arm or leg to check for issues in the skin or bones. The healthcare professional also looks for signs of infection and lumps. […] Imaging tests. MRI, CT, X-rays or ultrasound can help rule out other causes for the pain or confirm the diagnosis. These tests may show bone breaks or bruises, tumors, infection, or other bone issues. […] Blood tests. Blood tests may help rule out other causes for the pain or confirm the diagnosis.

• #12 Mayo Clinic Health Library – Residual limb pain | Swiss Medical Network

  https://www.swissmedical.net/fr/healtcare-library/con-20442786

  Residual limb pain is a type of pain felt in the part of an arm or leg that’s left after the arm or leg is removed, called amputation. More than half of people who have an amputation get this type of pain. Sometimes called stump pain, it may happen soon after the surgery, often within the first week. But the pain may last after healing. […] To diagnose residual limb pain, a healthcare professional looks for the cause. Some causes can be treated. Tests and procedures used to diagnose residual limb pain may include: […] Physical exam. A healthcare professional feels the residual arm or leg to check for issues in the skin or bones. The healthcare professional also looks for signs of infection and lumps. […] Imaging tests. MRI, CT, X-rays or ultrasound can help rule out other causes for the pain or confirm the diagnosis. These tests may show bone breaks or bruises, tumors, infection, or other bone issues. […] Blood tests. Blood tests may help rule out other causes for the pain or confirm the diagnosis.

• #13 Pain in the Residual Limb – Special Subjects – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/special-subjects/limb-prosthetics/pain-in-the-residual-limb

  Approximately 60% of individuals with an amputation have post-amputation pain in the residual limb, which can severely limit function, impair quality of life, and significantly impede rehabilitation. Residual limb pain should be evaluated and treated aggressively because some causes can be dangerous. […] Persistent residual limb pain is a chronic condition that differs from phantom limb pain and phantom limb sensation. […] Neuropathic pain is common in patients and is usually described as a shooting or burning pain and typically develops within 7 days of amputation. […] Painful neuroma can occur in any severed nerve (from surgery or trauma) and may cause a focal or enlarged area of pain that can be temporarily blocked (as a diagnostic maneuver) by local anesthetic injection. […] The diagnosis of a neuroma is suggested by history and physical examination. Pain from a neuroma may have neurogenic characteristics such as feeling electrical, shooting, tingling, sharp and stabbing, or prickly sensations. The pain is typically localized to the residual limb. […] Patients whose amputation was necessitated because of ischemic peripheral arterial disease are at risk for further ischemia, which can be difficult to diagnose but may be suggested by a very low transcutaneous oxygen tension.

• #14 Residual Limb Pain – Special Subjects – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/special-subjects/limb-prosthetics/residual-limb-pain

  Pain due to nerve damage (neuropathic pain) is common. Usually described as a shooting or burning pain, neuropathic pain typically develops within 7 days of amputation. […] Painful neuromas (noncancerous overgrowths of nerve tissue) can occur in any severed nerve (from surgery or trauma) and may cause pain that feels electrical, shooting, tingling, sharp and stabbing, or prickly. […] People whose amputation was necessitated by poor circulation (peripheral arterial disease) may have poor circulation in their residual limb, which can be difficult to diagnose. […] If there is no medical disorder causing the pain, massaging and light tapping combined with elevating the residual limb may help relieve the pain. […] Most people experience pain that feels as though it were occurring in the amputated limb (phantom limb pain) at some time.

• #15 Residual limb pain – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/residual-limb-pain/diagnosis-treatment/drc-20541405

  To diagnose residual limb pain, a healthcare professional looks for the cause. Some causes can be treated. Tests and procedures used to diagnose residual limb pain may include: […] Imaging tests. MRI, CT, X-rays or ultrasound can help rule out other causes for the pain or confirm the diagnosis. These tests may show bone breaks or bruises, tumors, infection, or other bone issues. […] Blood tests may help rule out other causes for the pain or confirm the diagnosis.

• #16 Residual limb pain – Hancock Health

  https://www.hancockhealth.org/mayo-health-library/residual-limb-pain/

  Residual limb pain is a type of pain felt in the part of an arm or leg thats left after the arm or leg is removed, called amputation. More than half of people who have an amputation get this type of pain. […] To diagnose residual limb pain, a healthcare professional looks for the cause. Some causes can be treated. Tests and procedures used to diagnose residual limb pain may include: […] Imaging tests. MRI, CT, X-rays or ultrasound can help rule out other causes for the pain or confirm the diagnosis. These tests may show bone breaks or bruises, tumors, infection, or other bone issues. […] Blood tests. Blood tests may help rule out other causes for the pain or confirm the diagnosis.

• #17 What Causes Stump Pain? | Nerve Conditions | IHTSC

  https://www.indianahandtoshoulder.com/blog/stump-pain

  A nerve pain doctor may order an MRI, CT scan, X-ray, ultrasound, or blood test to rule out some potential causes of pain, like a fracture, bone bruise, tumor, or infection. […] Once they have officially diagnosed what’s happening, your nerve pain specialist will discuss all available treatment options. […] If you see a nerve specialist, they may first recommend conservative therapies and treatments for residual limb pain. […] When stump pain doesn’t go away on its own, it’s essential to see a nerve specialist as soon as possible. […] Some causes of stump pain are treated most effectively with surgery. […] While residual limb pain will often go away on its own after a few weeks, that’s not the case for everyone. […] But with proper treatment, you can reduce pain, improve prosthetic use, and decrease the need for addictive narcotics.

• #18 The clinical significance of a swollen neuroma: a meaningful distinction or an incidental finding? – Svientek – Annals of Palliative Medicine

  https://apm.amegroups.org/article/view/55696/html

  Ultrasound imaging is not mandatory for the diagnosis of a symptomatic neuroma; however, ultrasounds can be useful in identifying smaller neuromas or confirming the presence of a neuroma in difficult cases. […] Other imaging modalities, including magnetic resonance imaging, computed tomography, and roentgenography, can be useful in ruling out other known causes of residual limb pain such as heterotopic ossification, osteophytes, bursitis, myositis, and infection. […] Despite these limitations, the authors are to be commended for their ability to recruit a considerable number of patients given the degree of rigorous testing involved in this study. […] This study indicates that while the presence of swollen neuromas is not a driver for either residual limb pain or phantom limb pain, the transected peripheral nerves still play a critical role in contributing to postamputation pain.

• #19 The clinical significance of a swollen neuroma: a meaningful distinction or an incidental finding? – Svientek – Annals of Palliative Medicine

  https://apm.amegroups.org/article/view/55696/html

  Symptomatic neuromas are a frequent contributor of residual limb pain, and the study by Buch et al. describes a well-designed investigation examining the relationship between swollen neuromas and postamputation pain. […] In this study, the authors found no statistically significant difference in the incidence of swollen neuromas in amputation patients with pain as compared to those without pain. In addition, there was no association between stump pain or phantom pain and the presence of swollen neuromas. Furthermore, the number of swollen neuromas did not seem to be associated with stump pain or phantom pain either. […] Our experience affirms the authors finding that identifiable swelling of a terminal nerve end is not in itself pathognomonic of a symptomatic (i.e., painful) neuroma. […] In our practice, the diagnosis of a symptomatic neuroma is largely a clinical one and is dependent on pain solicited from the end of the nerve.

• #20 Health Information Library | Rumah Sakit Pusat Pertamina

  https://rspp.co.id/dcontent.html?id=CON-20442786&n=Residual%20limb%20pain

  Residual limb pain is a type of pain felt in the part of an arm or leg that’s left after the arm or leg is removed, called amputation. More than half of people who have an amputation get this type of pain. Sometimes called stump pain, it may happen soon after the surgery, often within the first week. But the pain may last after healing. […] To diagnose residual limb pain, a healthcare professional looks for the cause. Some causes can be treated. Tests and procedures used to diagnose residual limb pain may include: […] A healthcare professional feels the residual arm or leg to check for issues in the skin or bones. The healthcare professional also looks for signs of infection and lumps. […] MRI, CT, X-rays or ultrasound can help rule out other causes for the pain or confirm the diagnosis. These tests may show bone breaks or bruises, tumors, infection, or other bone issues. […] Blood tests may help rule out other causes for the pain or confirm the diagnosis.

• #21 Phantom Limb Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27086

  The diagnosis of PLP pain is primarily a diagnosis of exclusion and heavily dependent on the patient’s history. Because of this lab tests are often not needed. A complete blood count (CBC) can help rule out infection. An ultrasound can be ordered to look for neuromas as a possible pain generator. A psychology evaluation may be indicated if the patient is having a significant amount of extrinsic triggers that may be contributing to his or her pain. […] Treatment, unfortunately, for PLP has not proven to be very effective. While treatment for RLP tends to focus on an organic cause for the pain, PLP focuses on symptomatic control. […] In the spinal cord, a process called central sensitization occurs. Central sensitization is a process where neural activity increases, the neuronal receptive field expands, and the nerves become hypersensitive. This is due to an increase in the N-methyl-D-aspartate, or NMDA, activity in the dorsal horn of the spinal cord making them more susceptible to activation by substance P, tachykinins, and neurokinins followed by an upregulation of the receptors in that area. This restructuring of the neural components of the spinal cord can cause the descending inhibitory fibers to lose their target sites. The combination of increased activity to nociceptive signals as well as a decrease in the inhibitory activity from the supraspinal centers is thought to be one of the major contributors to phantom limb pain.

• #22 Phantom Knee Pain: Symptoms, Causes, and Treatments

  https://www.physicianpartnersofamerica.com/health-news/health-wellness/phantom-knee-pain-symptoms-causes-and-treatments/

  Phantom knee pain is the perception of some form of discomfort or sensation in a knee that is no longer there due to amputation or surgery. […] RLP refers to pain that originates from the site of the amputation. […] Accurate diagnosis of the cause of residual and phantom knee pain is important. Examinations and procedures physicians will perform to better understand your sensations include: […] During a physical exam, your doctor will inspect the amputation site for signs of sores, infection, or masses. […] CT scans, MRIs, and ultrasounds may be used to get a more detailed view of your surgery site. This will also allow doctors to rule out other causes of pain, such as bone abnormalities and infection. […] Additionally, Electromyograms (EMG) and Nerve Conduction Studies (NCS), which check on how a patients muscles and nerves are functioning. The results from this test will help a pain specialist diagnose the severity of a patients condition, and accurately map the appropriate treatment options. […] Blood tests are used to screen for other possible causes of pain.

• #23 Phantom Knee Pain: Symptoms, Causes, and Treatments

  https://www.physicianpartnersofamerica.com/health-news/health-wellness/phantom-knee-pain-symptoms-causes-and-treatments/

  Phantom knee pain is the perception of some form of discomfort or sensation in a knee that is no longer there due to amputation or surgery. […] RLP refers to pain that originates from the site of the amputation. […] Accurate diagnosis of the cause of residual and phantom knee pain is important. Examinations and procedures physicians will perform to better understand your sensations include: […] During a physical exam, your doctor will inspect the amputation site for signs of sores, infection, or masses. […] CT scans, MRIs, and ultrasounds may be used to get a more detailed view of your surgery site. This will also allow doctors to rule out other causes of pain, such as bone abnormalities and infection. […] Additionally, Electromyograms (EMG) and Nerve Conduction Studies (NCS), which check on how a patients muscles and nerves are functioning. The results from this test will help a pain specialist diagnose the severity of a patients condition, and accurately map the appropriate treatment options. […] Blood tests are used to screen for other possible causes of pain.

• #24 Phantom Limb Pain Treatment Specialist in Minnesota

  https://www.nuraclinics.com/conditions/arm-and-leg-pain/phantom-limb-pain/

  Phantom limb pain is a sensation that occurs in people who have lost a limb — most commonly an arm, leg, hand or foot — but still feel discomfort or pain where it used to be. […] While the exact cause of phantom limb pain isn’t fully understood yet, there are still treatments available to help manage it. […] Our pain specialists will start by reviewing your medical history and discussing your symptoms. They’ll ask about any sensations or pain in the missing limb, exploring when it occurs and its emotional impact. During the exam, they’ll also check the remaining part of the limb for signs like extra sensitivity or muscle movements that feel like the missing limb is still there. […] In addition to the exam, our team may order specialized imaging like MRI or CT scans to rule out other potential causes of pain. Diagnostic nerve blocks may also be performed to confirm the diagnosis of phantom limb pain. By combining these techniques, we can accurately diagnose and develop an effective treatment plan to alleviate symptoms.

• #25 Guide | Physical Therapy Guide to Phantom Limb Pain | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-phantom-limb-pain

  Phantom limb pain is a painful or unpleasant sensation in a body part that has been surgically amputated or traumatically lost. The sensation may occur immediately following surgery or years later. Phantom pain is different from stump pain (or residual limb pain), which is localized in the remaining body part, or stump. […] There are no medical tests to diagnose phantom limb pain. Diagnosis is made based on your symptoms and the history of what occurred before the pain started. […] Your physical therapist will perform a careful examination of the bone and soft tissues of your stump to identify possible skin breakdown, infection, or abnormal pressure on weight-bearing contact points. […] Phantom limb pain needs to be managed to prevent symptom flare-ups, or to resolve the problem. Pain management includes treating the biological and complex mechanisms of the problem with different strategies. […] There is no clear evidence that phantom limb pain can be prevented. Pain management that eliminates symptoms before and after amputation may help limit the onset of pain and even prevent it.

• #26 Phantom limb pain, stump pain | Neurosurgery Inselspital Bern

  https://neurochirurgie.insel.ch/en/diseases-specialities/functional-neurosurgery-and-pain-syndromes/pain-syndromes/phantom-limb-pain-and-residual-limb-pain

  Phantom limb pain is a sensation of pain in an amputated limb although it is no longer physically part of the body. To be distinguished from this is residual limb pain or stump pain, which occurs directly at the amputation stump after an amputation and has a specific underlying physical cause. […] It is important to rule out residual limb pain and if this is present to treat the cause of the stump pain. […] Stump pain fundamentally differs from phantom limb pain, both in terms of its mechanisms of origin and its therapy. Stump pain is pain that occurs directly at the amputation stump, often due to wound pain, bruising, infection, or poorly adapted prostheses. […] If stump pain persists weeks after an amputation, it is important to look for a cause of the pain. The most common causes are: infections, amputation neuroma, heterotopic bone formation, wound dehiscence and bruising, poorly fitting prostheses. […] There have been no studies in the literature that have investigated the efficacy of neuromodulation in patients with stump pain.

• #27 Melbourne Pain Group | Phantom Pain

  https://www.melbournepaingroup.com.au/conditions/phantom-pain

  Phantom pain, sometime referred to as Phantom Limb Pain or simply 'PLP’ is the pain felt by someone who has had a part of their body removed or amputated and where the pain is coming from, or seems to come from, the amputated body part. […] A closely associated but different form of pain is 'residual limb pain’ sometimes called 'stump pain’, which again is felt by amputees but the pain is clearly coming from the remaining part of the limb. Residual limb pain and phantom limb pain often happen at the same time. […] Residual limb pain is also a known risk factor for developing phantom pain. […] Phantom limb pain is relatively straightforward to diagnose, however it is important to distinguish it from residual limb pain, where the cause of the pain may be for example, an infection or the presence of a neuroma (which is a tangle of nerve endings that sometimes forms after amputation or loss of a limb). […] Recognition that phantom limb pain is caused by a form of dysfunction of the remaining nerves, the spinal cord and/or the brain’s ability to sense pain, means that this type of pain needs to be treated quite differently from other types of pain.

• #28 An Algorithm Approach to Phantom Limb Pain | JPR

  https://www.dovepress.com/an-algorithm-approach-to-phantom-limb-pain-peer-reviewed-fulltext-article-JPR

  Kooijman et al reviewed data collected from 124 upper extremity amputees. They found a significant association between phantom pain and phantom sensation (relative risk 11.3) and between phantom pain and residual limb pain (relative risk 1.9). […] Understanding the duration and natural history of PLP remains elusive. […] The pain is often described as stabbing, shocking or burning at the end of the residual limb. Examination of the limb may reveal infection, neuromas or bone spurs that account for at least some of the pain. […] Neuroma formation is thought to contribute to residual limb pain and can sometimes be felt during examination of the residual limb. […] While peripheral factors likely play a role in the development of PLP, the lack of uniform and complete response to techniques such as regional anesthetic blocks suggests that central factors play an important role in both the development and maintenance of PLP.

• #29 Postamputation pain: a multidisciplinary review of epidemiology, mechanisms, prevention, and treatment | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/50/2/175

  Despite humanitys long experience with amputations, postamputation pain remains a highly prevalent, incompletely understood, and clinically challenging condition. There are two main types of postamputation pain: residual limb pain (including but not limited to the stump) and phantom limb pain. […] Residual limb pain tends to be more nociceptive, and it includes pain due to tissue injury (eg, amputation trauma, wound infection, foreign body/shrapnel, pressure ulcers, prosthetic irritation, and ischemia), heterotopic ossification, and direct or referred spinal or peripheral joint pain related to altered biomechanics. […] Although the category of postamputation pain can be discerned from patient localization, appropriate management requires the identification of underlying causes through history and physical examination, as well as consideration of diagnostic studies.

• #30 Living With Residual Limb Pain – Amputee Coalition

  https://amputee-coalition.org/resources/living-with-residual-limb-pain-fs/

  What is residual limb pain (RLP)? This is the 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 prior to your amputation. You and your healthcare team will want to work carefully together to understand the origin and cause of your pain in order to treat it successfully. […] Residual limb pain is different from this normal postoperative pain. For example, it commonly occurs after your postoperative pain has ended. It is frequently described as sharp, aching, throbbing or burning in nature. Your entire healthcare team, including your doctors, therapists and prosthetist, will work with you to determine the cause of this pain and decide what treatments might be most effective. […] No matter the cause of residual limb pain, there are some principles that can be followed to help you manage your pain.

• #31 Residual limb pain – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/residual-limb-pain/symptoms-causes/syc-20541403

  Residual limb pain is a type of pain felt in the part of an arm or leg that’s left after the arm or leg is removed, called amputation. More than half of people who have an amputation get this type of pain. Sometimes called stump pain, it may happen soon after the surgery, often within the first week. But the pain may last after healing. […] Residual limb pain symptoms can begin soon after surgery. Or they can start more than two years after the amputation. The type of pain may depend on the cause. People most often feel the pain at the end of the stump. Pain may feel like: Prickling. Throbbing. Burning. Squeezing. Stabbing. Cramping. […] There are several causes of pain after removal of an arm or leg, called amputation. They include the following: Issues in the bone or the soft tissue, such as sores or bone spurs. Infection. Poor blood supply to the part of the arm or leg that’s left. A tumor. A tangle of nerve endings that forms after the arm or leg is removed, called a neuroma. Nerve damage. Issues with the fit or use of a replacement arm or leg, called a prosthesis.

• #32 Residual Limb Pain – Special Subjects – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/special-subjects/limb-prosthetics/residual-limb-pain

  Pain due to nerve damage (neuropathic pain) is common. Usually described as a shooting or burning pain, neuropathic pain typically develops within 7 days of amputation. […] Painful neuromas (noncancerous overgrowths of nerve tissue) can occur in any severed nerve (from surgery or trauma) and may cause pain that feels electrical, shooting, tingling, sharp and stabbing, or prickly. […] People whose amputation was necessitated by poor circulation (peripheral arterial disease) may have poor circulation in their residual limb, which can be difficult to diagnose. […] If there is no medical disorder causing the pain, massaging and light tapping combined with elevating the residual limb may help relieve the pain. […] Most people experience pain that feels as though it were occurring in the amputated limb (phantom limb pain) at some time.

• #33 Phantom Limb Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27086

  PLP is often described as tingling, throbbing, sharp, pins/needles in the limb that is no longer there. It occurs more commonly in upper extremity amputations than lower extremities and tends to be intermittent in frequency. Pain severity varies, and onset can be immediate or years afterward. It is important to try and distinguish PLP from RLP. The goal of the physical exam is to rule out the causes of RLP. […] The first treatment is usually conservative and should include nonpharmacological and nonsurgical methods. The prosthetic professional should assess the stump and train the patient in the use of the prosthetic device. A mental health nurse and psychotherapist should help ease anxiety and depression. If this fails, the pharmacist should work with the clinician to select an appropriate agent, as well as educate the patient on the different pharmacological agents available, their effectiveness, and their adverse effects. A pain specialist should be involved as well.

• #34 Clinical features of phantom limb pain in patients with lower limb amputation in a Spanish population | Neurología (English Edition)

  https://www.elsevier.es/en-revista-neurologia-english-edition–495-articulo-clinical-features-phantom-limb-pain-S2173580825000094

  PLP is a prevalent pathology among amputee patients, therefore multidisciplinary care with an active neurologic participation is essential. Studies are needed to deepen the knowledge of the factors that favour the development of PLP in order to focus early and targeted therapies to prevent the appearance of PLP. […] Although many years have passed since the first descriptions of this phenomenon, there is still no consensus on the underlying mechanisms of PLP or the most appropriate treatment approach for these painful sensations. […] Pain assessment is particularly complex in patients with PLP since this pain originates in the amputated limb, and therefore the sensorineural circuits of pain change drastically after amputation. Another challenge in the assessment of PLS is the presence of other abnormal sensations following amputation, such as residual limb pain (RLP) or non-painful phantom sensations (NPPS), which hinder clinical diagnosis of PLP.

• #35 Phantom Limb Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448188/

  It is important to know the difference between the two because the causes and treatments for each differ, but also be aware that both of these elements can coexist at the same time. […] The goal of the physical exam is to rule out the causes of RLP. […] In terms of pain intensity, RLP usually is not severe, and features pressing, throbbing, burning, squeezing, and stabbing sensations. […] The diagnosis of PLP pain is primarily a diagnosis of exclusion and heavily dependent on the patient’s history. […] Because of this lab tests are often not needed. […] Treatment for RLP tends to focus on an organic cause for the pain, PLP focuses on symptomatic control. […] There is no one treatment that works reliably or consistently in all patients. […] Most patients are prescribed multiple agents to control pain, but tragically, this polypharmacy also has serious adverse effects that tend to lower compliance.

• #36 The clinical significance of a swollen neuroma: a meaningful distinction or an incidental finding? – Svientek – Annals of Palliative Medicine

  https://apm.amegroups.org/article/view/55696/html

  Symptomatic neuromas are a frequent contributor of residual limb pain, and the study by Buch et al. describes a well-designed investigation examining the relationship between swollen neuromas and postamputation pain. […] In this study, the authors found no statistically significant difference in the incidence of swollen neuromas in amputation patients with pain as compared to those without pain. In addition, there was no association between stump pain or phantom pain and the presence of swollen neuromas. Furthermore, the number of swollen neuromas did not seem to be associated with stump pain or phantom pain either. […] Our experience affirms the authors finding that identifiable swelling of a terminal nerve end is not in itself pathognomonic of a symptomatic (i.e., painful) neuroma. […] In our practice, the diagnosis of a symptomatic neuroma is largely a clinical one and is dependent on pain solicited from the end of the nerve.

• #37 27: Management of Pain in the Amputee | O&P Virtual Library

  http://www.oandplibrary.org/alp/chap27-01.asp

  The development of a neuroma is a natural repair phenomenon that occurs in any transection of a peripheral nerve. […] The importance of neuroma formation lies in its size and location. […] Injection of the neuroma site with local analgesics and steroids may alleviate the pain. […] The cause is thought to be an abnormal prolongation of the normal sympathetic response to injury. […] Although uncommon as sources of pain in the amputee, bursitis and tendinitis must be considered in the differential diagnosis of aggravating limb pain. […] The prosthesis draws the amputee’s attention to the involved limb. Thus any pain in the limb may be immediately associated in the patient’s mind with the amputation and the prosthesis.

• #38 27: Management of Pain in the Amputee | O&P Virtual Library

  http://www.oandplibrary.org/alp/chap27-01.asp

  The development of a neuroma is a natural repair phenomenon that occurs in any transection of a peripheral nerve. […] The importance of neuroma formation lies in its size and location. […] Injection of the neuroma site with local analgesics and steroids may alleviate the pain. […] The cause is thought to be an abnormal prolongation of the normal sympathetic response to injury. […] Although uncommon as sources of pain in the amputee, bursitis and tendinitis must be considered in the differential diagnosis of aggravating limb pain. […] The prosthesis draws the amputee’s attention to the involved limb. Thus any pain in the limb may be immediately associated in the patient’s mind with the amputation and the prosthesis.

• #39 Residual Limb Pain – Special Subjects – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/special-subjects/limb-prosthetics/residual-limb-pain

  Phantom limb pain usually begins within days following amputation but could be delayed months to years. […] Phantom limb pain is often worse soon after the amputation, then decreases over time. […] Some people with a traditional socket-secured prosthesis experience chronic, recurring residual limb pain caused by chronic skin irritation from sweating and pressure/friction ulcers. This results in having less control over the prosthesis, a loss of function, reduced independence, and a decreased quality of life. Persistent pain can affect sleep, increase stress levels, and increase mental health problems (for example. anxiety, depression, and substance use disorders).

• #40 Residual Limb Pain – Special Subjects – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/special-subjects/limb-prosthetics/residual-limb-pain

  Phantom limb pain usually begins within days following amputation but could be delayed months to years. […] Phantom limb pain is often worse soon after the amputation, then decreases over time. […] Some people with a traditional socket-secured prosthesis experience chronic, recurring residual limb pain caused by chronic skin irritation from sweating and pressure/friction ulcers. This results in having less control over the prosthesis, a loss of function, reduced independence, and a decreased quality of life. Persistent pain can affect sleep, increase stress levels, and increase mental health problems (for example. anxiety, depression, and substance use disorders).

• #41 Introduction to Residual Limb Pain

  https://www.armdynamics.com/upper-limb-library/introduction-to-residual-limb-pain

  Residual limb pain is experienced by at least half of all individuals with an amputation. It refers to any pain that is felt in the part of the limb that still exists. […] A person who has had a traumatic amputation may experience severe residual limb pain from tissue damage in the weeks following their amputation that should recede with time, healing and treatment. […] All residual limb pain should be reported to your doctor, your prosthetist and your clinical therapy specialist. Upper limb specialists are specially trained to diagnose the pain, and make sure it isnt phantom pain, as those can sometimes occur at the same time. […] Once you have a diagnosis, you can work with your care team to determine the best treatment options. Your doctor may prescribe medications or a surgical procedure. […] Our in-house tool is called The Comprehensive Arm Prosthesis and Rehabilitation Outcomes Questionnaire (CAPROQ) that, among other things, assesses pain and numbness to help guide your prosthetic rehabilitation.

• #42 Clinical features of phantom limb pain in patients with lower limb amputation in a Spanish population | Neurología (English Edition)

  https://www.elsevier.es/en-revista-neurologia-english-edition–495-articulo-clinical-features-phantom-limb-pain-S2173580825000094

  PLP is a prevalent pathology among amputee patients, therefore multidisciplinary care with an active neurologic participation is essential. Studies are needed to deepen the knowledge of the factors that favour the development of PLP in order to focus early and targeted therapies to prevent the appearance of PLP. […] Although many years have passed since the first descriptions of this phenomenon, there is still no consensus on the underlying mechanisms of PLP or the most appropriate treatment approach for these painful sensations. […] Pain assessment is particularly complex in patients with PLP since this pain originates in the amputated limb, and therefore the sensorineural circuits of pain change drastically after amputation. Another challenge in the assessment of PLS is the presence of other abnormal sensations following amputation, such as residual limb pain (RLP) or non-painful phantom sensations (NPPS), which hinder clinical diagnosis of PLP.

• #43 Residual limb pain – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/residual-limb-pain/symptoms-causes/syc-20541403

  Some studies have found that risk factors for residual limb pain may include: How high on the body the arm or leg was removed, called amputation. How much pain there was before amputation. The reason for the amputation. Older age at the time of amputation. […] Residual limb pain affects quality of life and may get in the way of using a replacement arm or leg, called a prosthesis. People with residual limb pain may be more likely to be depressed or anxious than people who don’t have the pain. […] A replacement limb, called a prothesis, that fits well can ease pressure between the residual limb and the prothesis. This can help prevent residual limb pain. Taking good care of the skin that comes into contact with the prothesis also can help prevent residual limb pain. […] Researchers are studying other ways to prevent residual limb pain after amputation.

• #44 Postamputation pain: a multidisciplinary review of epidemiology, mechanisms, prevention, and treatment | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/50/2/175

  The presence and severity of preamputation pain correlate with the presence and severity of phantom limb pain and residual limb pain. […] Postamputation pain is not a disease; it is a syndrome representing a constellation of signs and symptoms, with different etiologies and mechanisms, an absence of pathognomonic biomarkers, and a wide-ranging response to treatment. […] This review provides an overview of the diagnosis, risk factors, and mechanisms of postamputation pain, and discusses evidence-based strategies for its prevention and treatment.

• #45 Postamputation pain: a multidisciplinary review of epidemiology, mechanisms, prevention, and treatment | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/50/2/175

  The presence and severity of preamputation pain correlate with the presence and severity of phantom limb pain and residual limb pain. […] Postamputation pain is not a disease; it is a syndrome representing a constellation of signs and symptoms, with different etiologies and mechanisms, an absence of pathognomonic biomarkers, and a wide-ranging response to treatment. […] This review provides an overview of the diagnosis, risk factors, and mechanisms of postamputation pain, and discusses evidence-based strategies for its prevention and treatment.

• #46

  https://journals.lww.com/painrpts/fulltext/2021/01000/clinical_updates_on_phantom_limb_pain.7.aspx

  In the immediate postamputation period, about 50% of patients experience amputation residual limb pain (RLP). There is a strong correlation between RLP and PLP: patients affected with PLP show a higher presence of RLP in comparison to patients without PLP. […] Although this has not been shown in dedicated studies, patients with postamputation pain syndromes probably benefit from assessment, treatment, and monitoring within an interdisciplinary team including surgeons, anesthetists and pain physicians, psychologists, occupational therapists and physiotherapists, and orthopedic technicians. This should allow for optimizing potential synergistic effects and careful differential diagnosis. […] Main treatment options (for both prevention and established PLP) can be summarized under the following categories: surgical technique, prosthetic supply, pharmacotherapy including regional anesthesia, nonpharmacological treatment, education, and cognitive-behavioral therapy.

• #47 Phantom Limb Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27086

  PLP is often described as tingling, throbbing, sharp, pins/needles in the limb that is no longer there. It occurs more commonly in upper extremity amputations than lower extremities and tends to be intermittent in frequency. Pain severity varies, and onset can be immediate or years afterward. It is important to try and distinguish PLP from RLP. The goal of the physical exam is to rule out the causes of RLP. […] The first treatment is usually conservative and should include nonpharmacological and nonsurgical methods. The prosthetic professional should assess the stump and train the patient in the use of the prosthetic device. A mental health nurse and psychotherapist should help ease anxiety and depression. If this fails, the pharmacist should work with the clinician to select an appropriate agent, as well as educate the patient on the different pharmacological agents available, their effectiveness, and their adverse effects. A pain specialist should be involved as well.

• #48 Clinical features of phantom limb pain in patients with lower limb amputation in a Spanish population | Neurología (English Edition)

  https://www.elsevier.es/en-revista-neurologia-english-edition–495-articulo-clinical-features-phantom-limb-pain-S2173580825000094

  PLP is highly prevalent among patients with amputations and is frequently poorly controlled. A multidisciplinary approach is essential, with neurologists playing an active, central role. Future research should aim to deepen our knowledge of the risk factors for PLP; this would enable earlier implementation of more targeted preventive treatments.

• #49

  https://journals.lww.com/painrpts/fulltext/2021/01000/clinical_updates_on_phantom_limb_pain.7.aspx

  In addition to consequent treatment of severe perioperative pain, the essential aspect seems the early restoration of body scheme and function if possible associated with sensomotoric efference input. […] Phantom limb pain is highly prevalent after amputation. Treatment results will probably benefit from an interdisciplinary team and individually adapted surgical, prosthetic and pain medicine approaches.

• #50 Phantom Pain and Residual Limb Pain After Amputation FAQs | IHTSC

  https://www.indianahandtoshoulder.com/blog/phantom-pain-limb-pain-after-amputation-answers

  Treatment options for injured nerves during an amputation are successful at diminishing pain and phantom limb sensations, improving prosthetic use, and diminishing reliance on narcotics at any time point for amputees with post-amputation nerve pain. […] However, treatments are more effective if done at the same time or soon after the amputation occurs. We recommend amputees seek care as soon as possible to improve the likelihood of a successful outcome.

• #51 Residual Limb Pain – Special Subjects – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/special-subjects/limb-prosthetics/residual-limb-pain

  After an amputation, about 60% of people have pain in the residual limb, which can severely limit function, impair quality of life, and significantly impede rehabilitation. Residual limb pain should be evaluated and treated aggressively, because some causes can be dangerous. […] Persistent residual limb pain is a chronic condition that differs from phantom limb pain and phantom limb sensation. […] A person with residual limb pain should first check for signs of infection and skin breakdown. If infection looks likely, the doctor should be consulted. Even if there is no obvious signs of infection, the doctor should be consulted if pain is severe and sudden or if there is fever; these symptoms may indicate an infection. […] Surgical wound pain typically resolves as tissues heal, usually over 3 to 6 months. Pain continuing beyond that time has numerous causes, including infection and a poorly fitting preparatory prosthesis.

• #52 Phantom Pain and Residual Limb Pain After Amputation FAQs | IHTSC

  https://www.indianahandtoshoulder.com/blog/phantom-pain-limb-pain-after-amputation-answers

  Treatment options for injured nerves during an amputation are successful at diminishing pain and phantom limb sensations, improving prosthetic use, and diminishing reliance on narcotics at any time point for amputees with post-amputation nerve pain. […] However, treatments are more effective if done at the same time or soon after the amputation occurs. We recommend amputees seek care as soon as possible to improve the likelihood of a successful outcome.

• #53 Phantom Limb Pain: What It Is, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/12092-phantom-limb-pain

  Residual limb pain: This is pain that affects the remaining part of your limb (stump) thats still on your body after an amputation. Residual limb pain often has a medical reason, such as infection or nerve damage. […] You may also feel pain in the remaining part of your body that wasnt amputated. This is a residual limb or stump. Since this part of your body still exists, several complications can happen that may be causing the pain: […] You can experience residual limb pain at the same time as phantom limb pain. […] A healthcare provider will diagnose phantom limb pain after a physical exam and testing. […] Testing can help rule out other possible causes of your pain. […] Your treatment plan may include speaking with a mental health professional to manage stress, anxiety or depression that may be triggering phantom pain.

• #54 Melbourne Pain Group | Phantom Pain

  https://www.melbournepaingroup.com.au/conditions/phantom-pain

  Phantom pain, sometime referred to as Phantom Limb Pain or simply 'PLP’ is the pain felt by someone who has had a part of their body removed or amputated and where the pain is coming from, or seems to come from, the amputated body part. […] A closely associated but different form of pain is 'residual limb pain’ sometimes called 'stump pain’, which again is felt by amputees but the pain is clearly coming from the remaining part of the limb. Residual limb pain and phantom limb pain often happen at the same time. […] Residual limb pain is also a known risk factor for developing phantom pain. […] Phantom limb pain is relatively straightforward to diagnose, however it is important to distinguish it from residual limb pain, where the cause of the pain may be for example, an infection or the presence of a neuroma (which is a tangle of nerve endings that sometimes forms after amputation or loss of a limb). […] Recognition that phantom limb pain is caused by a form of dysfunction of the remaining nerves, the spinal cord and/or the brain’s ability to sense pain, means that this type of pain needs to be treated quite differently from other types of pain.

• #55 Phantom Limb Pain | Advanced Pain & Spine Management

  https://advancedpainspine.com/conditions/phantom-limb-pain/

  Although there is no medical test to diagnose phantom pain, doctors diagnose the disorder based on your symptoms and the circumstances that occurred before the pain began, such as trauma or surgery. […] Exactly describing your pain can assist your doctor in determining the source of your pain. Even though having phantom pain and residual limb pain at the same time is prevalent, the therapies for these two disorders may differ, so a proper diagnosis is critical.

• #56

  https://juniperpublishers.com/oajnn/OAJNN.MS.ID.555982.php

  Phantom limb pain (PLP) is commonly encountered in these patients, and it can vary in intensity, duration, and quality, ranging from throbbing or stabbing sensations to burning or cramping feelings. […] The diagnosis of PLP is primarily based on a thorough clinical evaluation, a review of prior medical history, and the patient’s reported symptoms. […] Phantom limb pain is a diagnosis of exclusion. History and physical examination are paramount in the appropriate identification of the condition. Diagnosis is based on the patient report and how the clinician conducts the evaluation, which presents a challenge due to subjectivity. […] It is essential to distinguish between Phantom limb pain and residual limb pain. Both conditions can present in a patient, independently or concurrently, and differ in their pathophysiology. While phantom limb pain is attributed to changes in the peripheral and central nervous system that presents as pain referred to an absent limb, residual limb pain, also named stump pain, localizes to the remaining portion, which can have different causes such as ischemia, neuroma, faulty prosthesis, soft tissue or bone damage. Treatment will be targeted according to the source.

• #57

  https://juniperpublishers.com/oajnn/OAJNN.MS.ID.555982.php

  Phantom limb pain (PLP) is commonly encountered in these patients, and it can vary in intensity, duration, and quality, ranging from throbbing or stabbing sensations to burning or cramping feelings. […] The diagnosis of PLP is primarily based on a thorough clinical evaluation, a review of prior medical history, and the patient’s reported symptoms. […] Phantom limb pain is a diagnosis of exclusion. History and physical examination are paramount in the appropriate identification of the condition. Diagnosis is based on the patient report and how the clinician conducts the evaluation, which presents a challenge due to subjectivity. […] It is essential to distinguish between Phantom limb pain and residual limb pain. Both conditions can present in a patient, independently or concurrently, and differ in their pathophysiology. While phantom limb pain is attributed to changes in the peripheral and central nervous system that presents as pain referred to an absent limb, residual limb pain, also named stump pain, localizes to the remaining portion, which can have different causes such as ischemia, neuroma, faulty prosthesis, soft tissue or bone damage. Treatment will be targeted according to the source.

• #58 Phantom Limb Pain – Condition And Treatment Information

  https://ainsworthinstitute.com/conditions/phantom-limb-pain/

  The pain might be triggered by certain bodily positions or movements. The pain can also be brought on or exacerbated by changes in the weather, or, in the case of amputation, pressure on the residual part of the limb. […] Psychological factors such as chronic stress and anxiety have been implicated in triggering pain as well. […] The pain itself can also change quality over time. Studies have shown that patients who experienced a sharp stabbing pain immediately after surgery have had it change in presentation to a squeezing or burning after 6 months. […] Pain usually decreased overall in the first 6 months as well. Phantom pain persisting longer than 6 months becomes increasingly difficult to treat. […] This pain can be felt as itching, aching or burning. […] The phantom limb pain discussed on this page can fall under the category of post-amputation pain as many patients of amputated limbs will experience it.

• #59 Phantom Limb Pain – Condition And Treatment Information

  https://ainsworthinstitute.com/conditions/phantom-limb-pain/

  The pain might be triggered by certain bodily positions or movements. The pain can also be brought on or exacerbated by changes in the weather, or, in the case of amputation, pressure on the residual part of the limb. […] Psychological factors such as chronic stress and anxiety have been implicated in triggering pain as well. […] The pain itself can also change quality over time. Studies have shown that patients who experienced a sharp stabbing pain immediately after surgery have had it change in presentation to a squeezing or burning after 6 months. […] Pain usually decreased overall in the first 6 months as well. Phantom pain persisting longer than 6 months becomes increasingly difficult to treat. […] This pain can be felt as itching, aching or burning. […] The phantom limb pain discussed on this page can fall under the category of post-amputation pain as many patients of amputated limbs will experience it.

• #60 2025 ICD-10-CM Diagnosis Code G54.6: Phantom limb syndrome with pain

  https://www.icd10data.com/ICD10CM/Codes/G00-G99/G50-G59/G54-/G54.6

  G54.6 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. […] The sensation of pain or other unpleasant feelings in the place of a missing (phantom) limb. […] Perception of painful and nonpainful phantom sensations that occur following the complete or partial loss of a limb. The majority of individuals with an amputated extremity will experience the impression that the limb is still present, and in many cases, painful.

• #61

  https://www.painscale.com/article/diagnosing-phantom-limb-pain

  Many people who have had an amputation feel pain, or other sensations, in the limb as if it is still attached. […] A physician should be able to identify phantom limb pain based on current symptoms and the circumstances that caused the limb removal. For proper treatment, it is imperative that the physician determines if the pain is a result of phantom limb pain or residual limb pain. […] A detailed description of the location and severity of the pain is needed by the physician to make a diagnosis. […] No specific medical tests exist to diagnose phantom limb pain. Certain tests such as MRIs or CAT scans may be ordered to determine if the part of the brain that handles pain sensitivity for the amputated limb is showing pain activity.

• #62 Neuroma and Phantom Limb Pain: Diagnosis & Treatment | IFAR

  https://www.advancedreconstruction.com/lower-extremity/neuroma-phantom-limb-pain

  Phantom limb pain is diagnosed based on the patient’s self-report of pain in a limb that has been amputated. It is important that providers listen carefully to the patient’s description of the pain and how it feels. […] In some cases, additional tests may be conducted to rule out other potential causes of the pain, such as nerve damage or infection. These tests may include imaging studies, such as X-rays or MRI scans, or nerve conduction studies. […] TMR is an advanced surgical procedure that involves transferring the sensory nerves that once provided sensation to an amputated limb to reinnervate other muscles to disrupt the painful sensory sensation. Following surgery, the nerves grow back into the new muscles thereby disrupting the sensory signal pathway and thus stopping the pain mechanism and phantom limb sensation. […] This procedure also prevents misdirected nerve growth, or neuroma formation, which can contribute to pain within the residual limb and/or cause PLP. […] TMR surgery can occur at the same time as or after an amputation to prevent neuromas from forming and causing phantom limb pain.

• #63 The clinical significance of a swollen neuroma: a meaningful distinction or an incidental finding? – Svientek – Annals of Palliative Medicine

  https://apm.amegroups.org/article/view/55696/html

  Ultrasound imaging is not mandatory for the diagnosis of a symptomatic neuroma; however, ultrasounds can be useful in identifying smaller neuromas or confirming the presence of a neuroma in difficult cases. […] Other imaging modalities, including magnetic resonance imaging, computed tomography, and roentgenography, can be useful in ruling out other known causes of residual limb pain such as heterotopic ossification, osteophytes, bursitis, myositis, and infection. […] Despite these limitations, the authors are to be commended for their ability to recruit a considerable number of patients given the degree of rigorous testing involved in this study. […] This study indicates that while the presence of swollen neuromas is not a driver for either residual limb pain or phantom limb pain, the transected peripheral nerves still play a critical role in contributing to postamputation pain.

• #64 Neuroma and Phantom Limb Pain: Diagnosis & Treatment | IFAR

  https://www.advancedreconstruction.com/lower-extremity/neuroma-phantom-limb-pain

  Phantom limb pain is diagnosed based on the patient’s self-report of pain in a limb that has been amputated. It is important that providers listen carefully to the patient’s description of the pain and how it feels. […] In some cases, additional tests may be conducted to rule out other potential causes of the pain, such as nerve damage or infection. These tests may include imaging studies, such as X-rays or MRI scans, or nerve conduction studies. […] TMR is an advanced surgical procedure that involves transferring the sensory nerves that once provided sensation to an amputated limb to reinnervate other muscles to disrupt the painful sensory sensation. Following surgery, the nerves grow back into the new muscles thereby disrupting the sensory signal pathway and thus stopping the pain mechanism and phantom limb sensation. […] This procedure also prevents misdirected nerve growth, or neuroma formation, which can contribute to pain within the residual limb and/or cause PLP. […] TMR surgery can occur at the same time as or after an amputation to prevent neuromas from forming and causing phantom limb pain.

• #65 Phantom Pain | PM&R KnowledgeNow

  https://now.aapmr.org/phantom-pain/

  There are no specific clinical guidelines for the management and treatment of phantom limb pain. […] Neuromas or other causes of pain can be surgically removed; however, stump revision should be reserved for cases of obvious pathology. […] A systematic review of amputation surgical techniques demonstrated that Targeted Muscle Reinnervation (TMR) and Regenerative Peripheral Nerve Interface (RPNI) are effective at prevention of phantom limb pain development.

• #66 Phantom Pain | PM&R KnowledgeNow

  https://now.aapmr.org/phantom-pain/

  There are no specific clinical guidelines for the management and treatment of phantom limb pain. […] Neuromas or other causes of pain can be surgically removed; however, stump revision should be reserved for cases of obvious pathology. […] A systematic review of amputation surgical techniques demonstrated that Targeted Muscle Reinnervation (TMR) and Regenerative Peripheral Nerve Interface (RPNI) are effective at prevention of phantom limb pain development.

• #67 Phantom Limb Pain: How TMR Can Help: Anthony Echo, MD: Plastic Surgeon

  https://www.anthonyechomd.com/blog/phantom-limb-pain-how-tmr-can-help

  Did you know that about 70% of amputees experience phantom limb pain? This condition results when the severed nerves continue to send signals to your brain, and it may arise as pain, itching, sensations of hot or cold, a feeling of pressure, or a pins-and-needles sensation. […] Losing a limb is difficult enough, but having to live with phantom limb pain can disrupt your daily life and may make wearing your prosthetic limb nearly impossible. […] If Dr. Echo finds youre a candidate for TMR, he begins with an evaluation of your pain using diagnostic testing to identify which nerves or neuromas are triggering the sensations. […] The only way to know for certain whether youre a candidate for TMR for phantom limb pain is to meet with Dr. Echo to review your specific case. Generally speaking, however, candidates for TMR are patients with: […] Residual limb pain that makes wearing a prosthetic difficult […] Residual limb pain that interferes with daily life. […] For qualified candidates, TMR is a reliable method of reducing phantom limb pain.

• #68 Diagnosing and Treating Pain After Amputation Surgery | University of Utah Health

  https://healthcare.utah.edu/healthfeed/2022/11/diagnosing-and-treating-pain-after-amputation-surgery

  After an amputation, some patients may feel pain in their residual limbs. Post-amputation pain, categorized as phantom pain or stump pain, can be a challenging condition to treat. […] Describing your post-amputation pain can help your doctor accurately diagnose and treat these two conditions. […] Although there’s no medical test to diagnose phantom pain, doctors identify the condition based on your symptoms and the knowledge that phantom pain could be caused by a miscommunication between your brain, spinal cord, and nerves that continues after your amputation. […] Stump pain, also called residual limb pain, is a type of pain felt in the part of a limb that remains after an amputation. […] Treatment for stump pain focuses on treating the underlying cause of the pain. […] Stump pain eventually improves without treatment in about half of the patients.

• #69 Phantom Limb Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448188/

  It is important to know the difference between the two because the causes and treatments for each differ, but also be aware that both of these elements can coexist at the same time. […] The goal of the physical exam is to rule out the causes of RLP. […] In terms of pain intensity, RLP usually is not severe, and features pressing, throbbing, burning, squeezing, and stabbing sensations. […] The diagnosis of PLP pain is primarily a diagnosis of exclusion and heavily dependent on the patient’s history. […] Because of this lab tests are often not needed. […] Treatment for RLP tends to focus on an organic cause for the pain, PLP focuses on symptomatic control. […] There is no one treatment that works reliably or consistently in all patients. […] Most patients are prescribed multiple agents to control pain, but tragically, this polypharmacy also has serious adverse effects that tend to lower compliance.

• #70 Phantom Limb Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27086

  In the United States (U.S.), 30,000 to 40,000 amputations are performed each year. Pain after amputation of a limb is a common symptom and is separated into two types of pain including residual limb pain (RLP) and phantom limb pain (PLP). This latter condition, formerly known as „stump pain”, is pain that originates from the actual site of the amputated limb. It is most common in the early post-amputation period and tends to resolve with wound healing. Unlike PLP, RLP is often a manifestation of an underlying source, such as nerve entrapment, neuroma formation, surgical trauma, ischemia, skin breakdown, or infection. […] It is important to know the difference between the two because the causes and treatments for each differ, but also be aware that both of these elements can coexist at the same time.

• #71

  https://www.eirmc.com/healthy-living/blog/surgical-innovations-for-managing-residual-and-phantom-limb-pain-after-amputation

  Both TMR and RPNI can change the lives of amputees who suffer from RLP and PLP. […] A physical exam and imaging tests are also part of Dr. Woodalls pre-op assessment. […] We match the surgery to the type of pain they have and what their goals are for prosthetic use. […] The outcome of any surgery to treat nerve pain is unpredictable and variable. […] But, as Dr. Woodall points out, even a reduction in pain is a big improvement for a patient who has been in a lot of pain. […] If we can reduce their pain by half and get them off some of their pain medications, then thats a win. It improves their overall quality of life. Thats worth the risk.

• #72

  https://www.eirmc.com/healthy-living/blog/surgical-innovations-for-managing-residual-and-phantom-limb-pain-after-amputation

  Both TMR and RPNI can change the lives of amputees who suffer from RLP and PLP. […] A physical exam and imaging tests are also part of Dr. Woodalls pre-op assessment. […] We match the surgery to the type of pain they have and what their goals are for prosthetic use. […] The outcome of any surgery to treat nerve pain is unpredictable and variable. […] But, as Dr. Woodall points out, even a reduction in pain is a big improvement for a patient who has been in a lot of pain. […] If we can reduce their pain by half and get them off some of their pain medications, then thats a win. It improves their overall quality of life. Thats worth the risk.

• #73 What Causes Stump Pain? | Nerve Conditions | IHTSC

  https://www.indianahandtoshoulder.com/blog/stump-pain

  A nerve pain doctor may order an MRI, CT scan, X-ray, ultrasound, or blood test to rule out some potential causes of pain, like a fracture, bone bruise, tumor, or infection. […] Once they have officially diagnosed what’s happening, your nerve pain specialist will discuss all available treatment options. […] If you see a nerve specialist, they may first recommend conservative therapies and treatments for residual limb pain. […] When stump pain doesn’t go away on its own, it’s essential to see a nerve specialist as soon as possible. […] Some causes of stump pain are treated most effectively with surgery. […] While residual limb pain will often go away on its own after a few weeks, that’s not the case for everyone. […] But with proper treatment, you can reduce pain, improve prosthetic use, and decrease the need for addictive narcotics.

• #74 What Causes Stump Pain? | Nerve Conditions | IHTSC

  https://www.indianahandtoshoulder.com/blog/stump-pain

  A nerve pain doctor may order an MRI, CT scan, X-ray, ultrasound, or blood test to rule out some potential causes of pain, like a fracture, bone bruise, tumor, or infection. […] Once they have officially diagnosed what’s happening, your nerve pain specialist will discuss all available treatment options. […] If you see a nerve specialist, they may first recommend conservative therapies and treatments for residual limb pain. […] When stump pain doesn’t go away on its own, it’s essential to see a nerve specialist as soon as possible. […] Some causes of stump pain are treated most effectively with surgery. […] While residual limb pain will often go away on its own after a few weeks, that’s not the case for everyone. […] But with proper treatment, you can reduce pain, improve prosthetic use, and decrease the need for addictive narcotics.

• #75 Clinical features of phantom limb pain in patients with lower limb amputation in a Spanish population | Neurología (English Edition)

  https://www.elsevier.es/en-revista-neurologia-english-edition–495-articulo-clinical-features-phantom-limb-pain-S2173580825000094

  PLP is highly prevalent among patients with amputations and is frequently poorly controlled. A multidisciplinary approach is essential, with neurologists playing an active, central role. Future research should aim to deepen our knowledge of the risk factors for PLP; this would enable earlier implementation of more targeted preventive treatments.

• #76

  https://juniperpublishers.com/oajnn/OAJNN.MS.ID.555982.php

  Phantom limb pain (PLP) is commonly encountered in these patients, and it can vary in intensity, duration, and quality, ranging from throbbing or stabbing sensations to burning or cramping feelings. […] The diagnosis of PLP is primarily based on a thorough clinical evaluation, a review of prior medical history, and the patient’s reported symptoms. […] Phantom limb pain is a diagnosis of exclusion. History and physical examination are paramount in the appropriate identification of the condition. Diagnosis is based on the patient report and how the clinician conducts the evaluation, which presents a challenge due to subjectivity. […] It is essential to distinguish between Phantom limb pain and residual limb pain. Both conditions can present in a patient, independently or concurrently, and differ in their pathophysiology. While phantom limb pain is attributed to changes in the peripheral and central nervous system that presents as pain referred to an absent limb, residual limb pain, also named stump pain, localizes to the remaining portion, which can have different causes such as ischemia, neuroma, faulty prosthesis, soft tissue or bone damage. Treatment will be targeted according to the source.

• #77 Living With Residual Limb Pain – Amputee Coalition

  https://amputee-coalition.org/resources/living-with-residual-limb-pain-fs/

  What is residual limb pain (RLP)? This is the 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 prior to your amputation. You and your healthcare team will want to work carefully together to understand the origin and cause of your pain in order to treat it successfully. […] Residual limb pain is different from this normal postoperative pain. For example, it commonly occurs after your postoperative pain has ended. It is frequently described as sharp, aching, throbbing or burning in nature. Your entire healthcare team, including your doctors, therapists and prosthetist, will work with you to determine the cause of this pain and decide what treatments might be most effective. […] No matter the cause of residual limb pain, there are some principles that can be followed to help you manage your pain.

• #78 Phantom Pain and Residual Limb Pain After Amputation FAQs | IHTSC

  https://www.indianahandtoshoulder.com/blog/phantom-pain-limb-pain-after-amputation-answers

  Treatment options for injured nerves during an amputation are successful at diminishing pain and phantom limb sensations, improving prosthetic use, and diminishing reliance on narcotics at any time point for amputees with post-amputation nerve pain. […] However, treatments are more effective if done at the same time or soon after the amputation occurs. We recommend amputees seek care as soon as possible to improve the likelihood of a successful outcome.

• #79 Residual limb pain – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/residual-limb-pain/symptoms-causes/syc-20541403

  Some studies have found that risk factors for residual limb pain may include: How high on the body the arm or leg was removed, called amputation. How much pain there was before amputation. The reason for the amputation. Older age at the time of amputation. […] Residual limb pain affects quality of life and may get in the way of using a replacement arm or leg, called a prosthesis. People with residual limb pain may be more likely to be depressed or anxious than people who don’t have the pain. […] A replacement limb, called a prothesis, that fits well can ease pressure between the residual limb and the prothesis. This can help prevent residual limb pain. Taking good care of the skin that comes into contact with the prothesis also can help prevent residual limb pain. […] Researchers are studying other ways to prevent residual limb pain after amputation.

• #80 Residual Limb Pain – Special Subjects – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/special-subjects/limb-prosthetics/residual-limb-pain

  Phantom limb pain usually begins within days following amputation but could be delayed months to years. […] Phantom limb pain is often worse soon after the amputation, then decreases over time. […] Some people with a traditional socket-secured prosthesis experience chronic, recurring residual limb pain caused by chronic skin irritation from sweating and pressure/friction ulcers. This results in having less control over the prosthesis, a loss of function, reduced independence, and a decreased quality of life. Persistent pain can affect sleep, increase stress levels, and increase mental health problems (for example. anxiety, depression, and substance use disorders).

Zobacz więcej