Post Amputation Pain Syndromes

Typical post amputation phenomena are stump pain (pain in the residual limb), phantom sensation and phantom limb pain. Of these, phantom sensation is ubiquitous, diminishes over time and cannot be treated. Stump pain can have multiple causes and requires careful assessment and targeted therapy depending on the causal diagnosis. Phantom limb pain occurs in 60–80% of all amputees and is the result of complex processes in the damaged peripheral nerves and the CNS. The most relevant risk factors are preoperative pain in the limb as well as psychological factors (such as depression and catastrophising) and severe pain in the early postoperative phase. A considerable number of preventive and therapeutic strategies are discussed, but the evidence for most of these is weak. As with all chronic pain states, a combination of pharmacological and non-pharmacological approaches to management should be utilised.