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. […] 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. […] 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. Emotional stress, such as fear and lack of emotional support, may make the pain worse.

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

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

  Stump pain, or residual limb pain, is common, affecting more than 75% of people who have undergone an amputation. […] Residual limb pain refers to pain that originates at the site where a limb was removed (or, as some call it, the “stump”). There are several potential causes of stump pain, with varying levels of severity. […] Residual limb pain can be related to the amputation itself or can be caused by a condition that occurred before or after the surgery. […] Examples of common causes of stump pain include: Infections, Poor blood supply, Problem with the fit of a prosthesis, Skin conditions, Surgical trauma, Growth or tumor, Poor tissue coverage at the end of the bone, Entrapment of nerves in the scar tissue, Peripheral nerve neuroma. […] Sometimes, after a part of the body (like an arm or finger) is removed, a nerve cut during the amputation will try to grow back but end up forming a neuroma. […] This is why some patients will feel pain (like a pinch or hot, burning sensation) in their stumps, or where their limbs were removed.

• #3 Chronic Post-Amputation Pain – Neuros Medical

  https://www.neurosmedical.com/chronic-post-amputation-pain/

  Post-amputation pain and sensation experiences can differ for amputees. Some experience pain that feels as if it is coming from the remaining limb stump, near the point of amputation. It can be a sharp or burning sensation. This is called residual limb pain. […] Many amputees experience chronic residual limb and phantom limb pain. […] Approximately 70% of amputees will have some degree of residual limb pain. […] 30% to 80% of amputees suffer from chronic pain for up to 20 years that requires advanced therapeutic treatment.

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

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

  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. […] 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.

• #5 Residual Limb Pain – The Nerve Surgery Centre

  https://nervesurgery.uk/residual-limb-pain/

  Pain after limb amputation is a common complication that affects many people who have undergone amputation. […] During the standard amputation, the nerves which served the amputated limb are cut and left freely in the tissues of the stump. […] A proportion of people who underwent the limb amputation, however, suffers from pain which can be a combination of the following causes: Phantom limb pain, Neuroma pain, Soft tissue stump pain caused by an unsatisfactory scar, lack of soft tissue to cover the underlying bone or skin conditions affecting the stump (ulcerations, stump dermatitis or infections). […] Phantom limb pain is a pain felt in the missing part of the limb after it has been amputated. About 75-80% of amputees experience this type of pain at some point after the amputation. […] The exact cause of phantom limb pain is not well understood, but it is thought to be related to changes in the brain and nervous system that occur after amputation.

• #6 Phantom Limb Pain – StatPearls – NCBI Bookshelf

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

  The exact etiology of PLP is unclear. Multiple theories have been debated, and the only agreement is that multiple mechanisms are likely responsible. The predominant theory for years involved the irritation of the severed nerve endings causing phantom pain. This was enforced by evidence that almost all amputation patients will develop neuromas in the residual limb. Over the last few decades, advances in imaging and laboratory techniques have shown evidence of central nervous system (CNS) involvement. Imaging studies such as MRI and PET scans show activity in the areas of the brain associated with the amputated limb when the patient feels phantom pain. The pain is now thought to involve many peripheral and central nervous system factors. […] The following underlying causes are given clinical consideration: Vascular etiologies (most common), Trauma, Cancer/malignancy, Congenital conditions.

• #7 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

  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. […] Most patients experience phantom limb pain at some time. The phantom aspect is not the pain, which is real, but the location of the pain in a limb that has been amputated. […] Phantom limb pain is often more severe soon after the amputation, then decreases over time. […] Some patients with a socket-secured prosthesis (SSP) experience chronic, recurring residual limb pain caused by chronic skin irritation from sweating and pressure/friction ulcers. […] Persistent pain can affect sleep, increase stress levels, and increase mental health problems (eg. anxiety, depression, substance use disorders). […] Persistent pain is more common in patients with short remaining skeletal structures and/or soft-tissue deformities of the residual limb.

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

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

  Stump pain, or residual limb pain, is common, affecting more than 75% of people who have undergone an amputation. […] Residual limb pain refers to pain that originates at the site where a limb was removed (or, as some call it, the “stump”). There are several potential causes of stump pain, with varying levels of severity. […] Residual limb pain can be related to the amputation itself or can be caused by a condition that occurred before or after the surgery. […] Examples of common causes of stump pain include: Infections, Poor blood supply, Problem with the fit of a prosthesis, Skin conditions, Surgical trauma, Growth or tumor, Poor tissue coverage at the end of the bone, Entrapment of nerves in the scar tissue, Peripheral nerve neuroma. […] Sometimes, after a part of the body (like an arm or finger) is removed, a nerve cut during the amputation will try to grow back but end up forming a neuroma. […] This is why some patients will feel pain (like a pinch or hot, burning sensation) in their stumps, or where their limbs were removed.

• #9 Phantom Limb Pain – StatPearls – NCBI Bookshelf

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

  During the amputation, there is a significant amount of trauma that occurs in the nerves and surrounding tissues. This damage disrupts the normal afferent and efferent signals involved with the missing limb. The proximal portions of the severed nerves start to sprout neuromas, and the nerves become hyper-excitable due to an increase in sodium-channels and resulting in spontaneous discharges. […] 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.

• #10 Phantom Limb Pain – OpenAnesthesia

  https://www.openanesthesia.org/keywords/phantom-limb-pain/

  Proximal ends of the dorsal root ganglion (DRG) are disconnected from the spinal cord following amputation causing inflammation and sprouting in the residual limb. […] DRG hyperactivity occurs due to the upregulation of sodium channels, downregulation of potassium channels, increased expression of neurotrophic factors, and the formation of sympathetic noradrenergic axons into the DRG.

• #11 movao: Questions about Phantom pain

  https://c.movao.community/topics/phantom-pain/questions-about-phantom-pain

  A neuroma is a tangled mass of neuronal tissue that can occur with a damaged nerve. It can be extremely sensitive, especially when your prosthesis (socket) presses against it. […] An excessive amount of bone sometimes forms around the end of the amputated limb. This „extra” bone can create pressure points that cause problems with the fit of your prosthesis.

• #12 Residual limb pain | Beacon Health System

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

  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. […] Treatment for residual limb pain depends on the cause. For some people with residual limb pain, the pain gets better in time without treatment. Treatments for residual limb pain may involve medicines, therapies or procedures. […] Neuromas are a major cause of residual limb pain.

• #13 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. […] Persistent residual limb pain is a chronic condition that differs from phantom limb pain and phantom limb sensation. […] Causes of residual limb pain include surgical pain, skin infection, deep tissue infection (for example, infection in the bone), pressure points with or without skin breakdown, excessive growth of nerve tissue (a neuroma), damage to nerves (neuropathy), bone spurs, lack of blood flow to the limb (ischemia), phantom limb pain, and complex regional pain syndrome. […] 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.

• #14 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. […] 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. […] Possible Causes of Residual Limb Pain include: Underlying disease process such as skin problems and infection and nerve pain (neuropathy), especially if you have diabetes or circulatory problems. Surgical trauma, including decreased blood supply to your limb or poor tissue coverage at the end of the bone. Neuroma formation. Entrapment of nerves in scar tissue.

• #14 Living With Residual Limb Pain – Amputee Coalition

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

  Poor tissue coverage can be caused by the bone at the end of your residual limb not being properly trimmed at the time of surgery, and this can cause pain when you wear your prosthesis. […] A neuroma is a collection, or bundle, of nerve endings that forms under the skin of your residual limb. […] Unfortunately, surgery to remove neuromas is not usually successful, because they often just reform. […] Occasionally, excess bone forms abnormally around the end of the amputated limb; this is sometimes called a “bone spur.” The “extra” bone may cause pressure points that interfere with the fit of your prosthesis; this occurs more frequently in children than adults. […] As your incision begins to heal, your doctor will let you know when you can start massaging your residual limb. This will help to prevent nerves from being “caught” in scar tissue. […] No matter the cause of residual limb pain, there are some principles that can be followed to help you manage your pain.

• #15 Pain Treatment MD – Pain Management for Phantom Limb Pain in Arkansas

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

  Phantom limb pain can also be felt in the remaining part of your body after the amputation, that is the residual limb or stump. Since this part of your body still exists, several complications can happen that may lead to the experience of phantom limb pain. Pain can be caused by: […] Pain can be caused by: […] Bruising […] Bone infection […] Nerve damage […] Inflammation […] Incorrect signal by the nervous system […] Poor blood flow […] Pressure injury […] This is the pain that affects that part of your body that is left behind after the amputation of the residual limb or the stump. This pain often has medical reasons such as infection or nerve damage.

• #16

  https://link.springer.com/article/10.1007/s40141-014-0063-0

  Infection of residual limbs is an unfortunate but expected complication that occurs in 20-41 % of amputations due to trauma or vascular disease, especially in one-stage surgery. […] Bursitis is a common source of frustration for patients, because it can cause symptoms ranging from prosthesis-related nuisance to disabling pain. […] Deep, proximal traction neurectomies during amputation surgery seek to avoid neuroma-related symptoms, but many amputees still experience the unpleasant presence of a symptomatic neuroma. […] Myodesis failure is not a common occurrence. […] Though relatively rare, an inadequate or ruptured myodesis can cause debilitating residual limb pain, an inefficient gait cycle, and ulceration. […] Bone spurs or osteophytes can be caused by a change in loading pressure of the bone, as in osteoarthritis, or result from periosteal stripping during a surgical procedure or traumatic event, such as amputation. […] HO is the formation of mature lamellar bone in non-osseous tissue. Lesions are often asymptomatic, but resultant pain or joint stiffness can severely impact patient function.

• #17 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. […] Causes of residual limb pain include postoperative surgical pain, skin infection, deep tissue infection (eg, osteomyelitis, vascular graft infection), pressure points with or without skin breakdown, neuroma, neuropathy, bone spurs, limb ischemia, phantom limb pain, and complex regional pain syndrome. […] Pain continuing beyond that time has numerous causes, including infection, wound dehiscence, arterial insufficiency, hematoma, insufficient muscle padding over cut ends of bone, and a poorly fitting preparatory prosthesis.

• #18 Residual Limb Pain – The Nerve Surgery Centre

  https://nervesurgery.uk/residual-limb-pain/

  Pain after limb amputation is a common complication that affects many people who have undergone amputation. […] During the standard amputation, the nerves which served the amputated limb are cut and left freely in the tissues of the stump. […] A proportion of people who underwent the limb amputation, however, suffers from pain which can be a combination of the following causes: Phantom limb pain, Neuroma pain, Soft tissue stump pain caused by an unsatisfactory scar, lack of soft tissue to cover the underlying bone or skin conditions affecting the stump (ulcerations, stump dermatitis or infections). […] Phantom limb pain is a pain felt in the missing part of the limb after it has been amputated. About 75-80% of amputees experience this type of pain at some point after the amputation. […] The exact cause of phantom limb pain is not well understood, but it is thought to be related to changes in the brain and nervous system that occur after amputation.

• #19 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. […] 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. […] 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. Emotional stress, such as fear and lack of emotional support, may make the pain worse.

• #20 Phantom Limb Pain – StatPearls – NCBI Bookshelf

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

  Over the past few years, there has been significant research into cortical reorganization and is a commonly cited factor in phantom limb pain. During this process, the areas of the cortex that represent the amputated area are taken over by the neighboring regions in both the primary somatosensory and the motor cortex. Cortical reorganization partially explains why nociceptive stimulation of the nerves in the residual limb and surrounding area can cause pain and sensation in the missing limb. […] Chronic pain has been shown to be multi-factorial with a strong psychological component. Phantom limb pain can often develop into chronic pain syndrome and for treatment to have a higher chance of success the patient’s pain behaviors and pain processing should be addressed. Depression, anxiety, and increased stress are all triggers for phantom limb pain.

• #21

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

  The persistence of PLP most likely is a multifactorial process driven by somatic, psychological, and social factors (similar to other chronic pain conditions), despite a seemingly universal cause in the unavoidable nerve injury with respective peripheral and central changes in the nervous system. […] 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. […] In some patients, RLP persists or develops in the context of wound healing disorders, osteitis, osteomyelitis, local circulatory disorders, neuroma, hematoma, or seroma. […] Residual limb pain is also associated with inappropriate preparation of the stump (eg, unfavorable formation of the bony stump end), inaccurate alignment of bone lengths in stumps with 2 or more bones (eg, metatarsus, lower leg, or forearm), and missing fat pad under mesh-graft after surgical treatment of soft tissue injuries resulting in improper fit of the prosthesis. […] Neuromas can not only trigger PLP but can also cause localized allodynia, hyperalgesia, and pain hindering prosthesis use. […] This can further be deteriorated by mechanical stress through rubber stockings of the prosthesis.

• #22 Residual Limb Pain – The Nerve Surgery Centre

  https://nervesurgery.uk/residual-limb-pain/

  It has been observed that problematic neuromas in the amputation stump can contribute to developing of phantom limb pain, as after treatment of the neuromas the phantom limb pain improved as well. […] Neuroma pain in an amputation stump is also a common complication that can occur after amputation surgery. […] The neuroma pain is different from the phantom limb pain in that it is commonly felt in the stump rather than in the missing part of the limb. […] It is important to note that neuroma pain and phantom limb pain often exist together and neuroma pain may be driving the phantom limb pain.

• #23 movao: Questions about Phantom pain

  https://c.movao.community/topics/phantom-pain/questions-about-phantom-pain

  After an amputation of a body part, no fewer than 80% of people experience phantom sensations, residual limb pain and phantom pain. But what is the difference? Phantom sensations are non-painful feelings in an amputated limb, such as heat or tingling or the feeling that your fingers or toes are extended or shortened. With residual limb pain, the amputee primarily experiences pain in the residual limb, not in the amputated body part. Phantom pain is nerve pain in an absent limb. […] The exact cause of phantom sensations and phantom pain is not known. One possible explanation is that the nerves in our nervous system and brain are „rewired”, so that they no longer receive signals from a certain body part. […] Incidentally, there is a link between residual limb pain and phantom pain: painful areas of the residual limb (called trigger points) can cause/trigger phantom pain and phantom sensations.

• #24 Phantom Limb Pain – Novus Spine & Pain Center

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

  Phantom limb pain is a sensation that feels like it originates from an amputated body part. […] The exact cause of phantom pain is unclear. However, the pain appears to originate in the spinal cord and brain. […] Some other factors may also contribute to phantom limb pain, including damaged nerve endings, and scar tissue at the site of an amputation. It is also possible the phantom pain may mimic pain present in the limb before the amputation. […] Researchers have found that if pain was present in a limb before amputation, patients are more likely to have pain afterward, especially immediately after amputation. […] Amputees with persistent stump pain usually have phantom pain, as well. Stump pain can be the result of an abnormal growth on damaged nerve endings (neuroma). […] If a person experiences pain in a limb scheduled for amputation, there is a greater risk of developing phantom pain after the amputation.

• #25 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. […] 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 thats 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. […] 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.

• #26 Residual Limb Pain | qualifyingconditions

  https://www.qualifyingconditions.com/copy-of-reflex-sympathetic-dystroph

  Following a lower limb amputation, because of altered gait pattern, decreased weight load, disuse atrophy and lack of muscular action, its not uncommon for those with residual limb pain to also develop osteoporosis, or a loss in bone density. […] While pain medications are commonly used to help manage discomfort, treatments for residual limb pain also focus on managing the underlying cause of the pain. For pre-existing conditions like diabetes, treatment focus is on managing the condition through medications and lifestyle changes. When a loss of tissue or the development of bone spurs is the cause, additional padding and prosthetic adjustments may help, but in some causes surgery may be necessary to revise the residual limb or remove the extra bone. To treat residual limb pain caused by neuromas, non-steroidal antiinflammatory, antidepressant and anticonvulsant medications, as well as ultrasound, massage, vibration, percussion, acupuncture and transcutaneous electrical nerve stimulation are traditionally effective for reducing pain.

• #27 Prevalence of residual limb pain and symptomatic neuromas after lower extremity amputation: a systematic review and meta-analysis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33470746/

  Residual limb pain (RLP) is associated with (partial) extremity amputations and is defined as pain felt in the remaining part of the amputated limb. A common cause of RLP is neuroma formation after nerve transections. Neuromas can be very painful and severely debilitating pathologies, preventing prosthetic use, reducing quality of life, and requiring medication. […] The prevalence of RLP and symptomatic neuroma in patients who have had a lower extremity amputation is 59% and 15%, respectively. Knowledge of their high prevalence may result in better awareness among physicians, in turn providing timely and adequate management.

• #28

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

  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. […] Phantom limb syndrome refers to the perception of sensations or symptoms associated with an amputated limb that no longer exists, such as pain. The exact mechanisms involved in phantom limb pain are not fully understood. However, it is estimated that 60-85% of people who have undergone limb amputation may develop it. PLP usually occurs within the first 6 months after surgery, regardless of age, gender, level, or side of amputation. There is more prevalence in the lower limbs than in the upper limbs. Given its multifactorial etiology and complex neurocognitive disturbance, pain is one of PLS’s most frequent and challenging symptoms.

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