Spinal cord and peripheral nerve stimulation have been performed with varying results. Interventional Pain Management Treatments TENS (transcutaneous electrical nerve stimulation) of the stump.Physical Therapy and Behavioral Interventions ( 6) Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs).Providers should remember to look for causes of stump pain and treat these since addressing the cause may reduce the incidence or severity of phantom pain. Treatment can be challenging and should entail a multimodal and multidisciplinary approach that includes oral pain medications combined with rehabilitation therapy (i.e. What Treatments are Available for Post-Amputation Pain? A significant association has been found between stump pain and phantom limb pain. For instance, lingering stump problems such as scars, neuromas (a post-amputation growth containing nervous-system tissue), or bone spurs can directly influence the intensity and duration of phantom pain. Stump pain and phantom pain are interconnected. In 5 to 10% of patients, stump pain persists and can even get worse over time.
Stump pain is common in the early post-amputation period but diminishes as healing occurs. May be associated with catastrophizing and certain pain coping-strategies and beliefs.Phantom sensations are associated with phantom pain.Poor stump condition and stump pains are associated with phantom pain.children have lower incidence than adults Area of limb amputation closer to the body > area of limb amputation farther from the body.
Amputation on both sides > amputation on only one side. Traumatic amputation > surgical amputation. Relative risks are indicated as: Greater risks (top) > lesser risks (bottom) Risk Factors for Developing Post-Amputation Pain Meanwhile, in the brain, as other functions gradually take over the part of the brain that had been linked to the limb, painful sensations may arise. At the end of the stump, nerve fibers may grow a mass, or neuroma, that sends disordered signals to the brain. This type of pain is believed to stem from mixed signals that arise from the residual limb or brain. This symptom change is referred to as telescoping. However in 50% of cases, especially upper limb phantoms, the missing arm seems to get progressively shorter until the patient is left with a sensation of the phantom hand alone, dangling from the stump. With time the sensation of a phantom body part can fade away. Occasionally the discomfort will progress to severe pain that includes intermittent tremors and muscle spasms. Phantom sensations may be mild at first and decline over time, yet remain to some degree indefinitely. Phantom pain has been described after mastectomy ( phantom breast syndrome), eye removal and even after teeth extraction. Phantom limb pain is a type of post-amputation pain that can occur in any part of the body that no longer exists. ( 4) These sensations may be generalized to the entire missing limb or localized to specific anatomical regions such as the fingers or toes. Non-painful sensations may include feelings of numbness, itching, paresthesias, twisting, pressure or even the perception of involuntary muscle movements in the residual limb at the amputation site. The pain is often described as aching, throbbing, shooting, cramping, or burning. Post-amputation pain is a broad “catch-all” term, often used to refer to any of the aforementioned (without distinction) or even simply the general pain from the trauma of the amputation itself. Phantom limb sensation – sensation or perception of movement coming from the missing limb or body part. Phantom limb pain – pain or discomfort felt to be coming from the missing limb or body part. Residual limb pain – pain or discomfort experienced in or at the stump of the amputated limb. ( 1- 2) Pain following an amputation may develop as either residual limb pain, phantom limb pain, or phantom limb sensation. Amputation pain occurs in approximately 60 to 70% of patients, often arising weeks or months after a limb has been removed due to accident, injury, or disease. 
Post-amputation pain is a poorly understood, yet common, condition that causes significant disability and can be difficult to treat. 6, 2018.Post-Amputation Pain and Phantom Limb Pain Phantom limb pain: Peripheral neuromodulatory and neuroprosthetic approaches to treatment. In: Challenging Neuropathic Pain Syndromes: Evaluation and Evidence-Based Treatment. Rochester, Minn.: Mayo Foundation for Medical Education and Research 2018.
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