Post-Amputation Phantom-Limb and Neuroma Pain

Amputations of the upper and lower extremities may be performed from the fingertips to the shoulder or from the toes to the hip and often are performed due to trauma, infection, peripheral vascular disease, or cancer. One aspect of the procedure to perform an amputation requires cutting all of the nerves at the level of the amputation. These injured nerves are at risk of forming a neuroma, which is a painful ball-like growth at the end of an injured nerve. Neuromas can cause sharp, burning, or electric shock-like sensations near the amputation site or within the residual limb. Additionally, amputees may experience phantom limb pain, which is a perception of the amputated limb still being present and which typically can be associated with pain or discomfort. Both neuroma and phantom limb pain can significantly impair an amputee's quality of life, limit the use of prosthetic devices, and reduce the functionality of the amputated limb. Early identification and treatment of this and a comprehensive multidisciplinary treatment plan are essential for managing these painful conditions.

For patients with prior amputations and established phantom limb pain and/or neuroma pain, an evaluation would include a discussion regarding the frequency and severity of the pain and a careful assessment of the amputation site to identify neuromas and consideration for nerve blocks with injection of a local anesthetic. Patients undergoing scheduled amputations, such as for removal of tumors, may be candidates for procedures such as targeted muscle reinnervation) TMR and regenerative peripheral nerve interface (RPNI) at the time of their amputation to reduce the risk of post-operative phantom limb pain and/or neuroma pain.

Until recently, most treatment strategies involved medications including opioids, physical therapy, or patients simply “dealing with” the pain. However, none of these treatments address the underlying problem, which is the injured nerve that used to go to a muscle or patch of skin now has no target.

Recent advances have introduced new options for treating these debilitating conditions, which often can provide pain relief at the amputation site or residual limb. By providing the nerve with a destination and purpose, the incidence of phantom limb pain and neuroma pain can be reduced. This can be achieved with procedures including TMR and RPNI surgery, both of which are explained further at these links.

Non-surgical treatment options, such as nerve stimulation techniques (e.g., transcutaneous electrical nerve stimulation (TENS), spinal cord stimulation, or peripheral nerve stimulation), may also be considered for patients who are not candidates for surgery or prefer a less invasive approach. However, these non-surgical treatments do not provide the same physiologic solution as TMR and RPNI surgery.

Surgery typically can be done as an outpatient with same day surgery or with an overnight stay. Although there may be some localized post-operative pain or occasional nerve pain flare-ups, this usually subsides quickly. Prosthesis wear may resume once the surgical wounds are fully healed, which generally is by around 6 weeks post-operatively.

Be sure to see an experienced surgeon to treat this condition. Our fellowship-trained specialists at The Buncke Clinic in San Francisco treat patients with amputee pain from across the Bay Area and Northern California. Contact us to schedule a consultation.