Where is this pain coming from?

 Pain after Amputation?

   Where does it come from? There are several types of pain following an amputation; acute/surgical pain, phantom pain/sensation, residual limb pain. We are going to work through each of these and try to take some of the mystery out of them. Okay, so let's start with the most obvious pain...surgical pain.

    Surgical pain is fairly obvious in that the amputation you had causes bone, soft tissue and nerve "injury." Bone heals in approximately 6 weeks (just like it would if you had broken it) this timeline can vary depending on age, overall general health, and each individual's history with healing. This pain decreases over time. It may not seem like it and that may be due to a different type of pain known as residual limb pain.

    Residual limb pain is pain in the remaining/residual portion of the limb following amputation. This is not typically felt in the days/weeks following surgery. This type of pain is more often present once the healing of bone and soft tissue have occurred and is only present in the limb without symptoms going below the level of the amputation. This pain can be triggered if there are neuromas present, if there has been delayed wound healing, if there were surgical complications, it can come from poor prosthetic fit, this is not all options but may be a possibility.

    Phantom limb pain this can be felt immediately after amputation surgery or start days/weeks/months later. This is pain that is beyond the end of the residual limb may be present in the area where a toe/finger or an ankle would have been, or it may travel from the site of amputation down towards the fingers or toes. The frequency and severity of the pain can vary from person to person and day to day. As a therapist who has worked with over a hundred individuals post amputation phantom limb pain is extremely variable based on the patient. It can be pain at the site of a previous wound, it can feel like an electrical shock going down the limb, or it can be a nebulous sense of pain where there is no limb. You are NOT crazy if you feel this, this is fairly normal for all individuals post amputation. 

   Phantom limb sensation can occur with or without pain and this can be sensations of itching or the sense that the rest of the limb is still there. This is what can put individuals with lower extremity amputations at risk for falls as most individuals will say something like, "I thought my leg was still there when I stood up to go to the bathroom." The limb may feel like it is moving when it is not or you may feel the surface that is under "your foot" even when nothing is touching the residual limb. This sensation can appear to be more intense at the end of the day when the prosthesis is off, possibly due to timeframe at the end of the day most people are trying to calm down and prepare for sleep so there is less distraction for what is going on with your leg. It could also be due to the fact that the input from wearing the prosthesis is now gone and the nerves are more primed for input.

To find things you can do at home for ways to treat pain after amputation please read my next blog post.

Thank you for any questions or feedback.

Terminology: What is all of this medical jargon?

Did you ever wonder what the words meant when you looked at your medical records? Or when you were talking to someone in the medical field and they forgot to use layman's terms. I want to make sure that you have some of the vocabulary down so that you can also better advocate for yourself. 

Residual Limb: This is the remaining portion of your arm or leg following an amputation.

Transtibial Amputation: This is an amputation of the leg below the knee but above the ankle

Knee Disarticulation: This is an amputation of the leg through the knee joint, leaving none of the leg from the knee down

Transfemoral Amputation: This is an amputation of the leg above the knee but below the hip 

Hip Disarticulation: This is an amputation of the leg at the hip joint, leaving none of the leg from the hip down.

Liner: This is the first part of the leg donned before you put on socks or your socket

Socket: Hard outer portion that contains the residual limb (in the picture below it is the flesh tone portion)

Flexible Inner Socket: In most prosthetic devices it is between the socket and your leg. Most of the flexible inner liner come out to help adjust for sock ply, for those days when your leg is swollen and you don't have socks on. (in the picture above it is the clear layer, though often it can be white)

Pylon: Is the section of metal pole that connects your socket to the next mechanical joint, it could above and below the knee or just below the knee depending on the level of your amputation. (below are two different examples of transtibial prosthetic legs, the one on the R has a long pylon and the one of the left has a very short pylon near the bottom or distal end of the socket)

Proximal: It is the portion of your closer to your center or point of attachment to your body. 

            Example: Your shoulder is proximal to your elbow.

Distal: This is the opposite of proximal and is the portion of you further from your center or point of attachment to your body. 

            Example: Your fingers are distal to your wrist.

Medial: This is the part of the body closest to midline or center of the body. 

            Example: The big toe is medial to the little toe.

Lateral: This is the opposite of medial and the side furthest from midline or center of the body.

Phantom Limb Sensation: This is when you feel numbness or tingling, itching, or any other sensation that is not pain extending below/distal to the level of the amputation.

Phantom Limb Pain: Any pain that extends below/distal to the level of the amputation. 

Neuroma: a very specific area of pain, sometimes a nodule or small ball like structure can be felt with palpation. This is where one of the cut ends of a nerve have "balled" up and may include some scar tissue creating a very tender area that can make wearing a prosthesis painful.

Hopefully you have found information to take away some of the mystery that medical language creates and if you have any questions regarding other words that maybe I should have included please comment with those and I will include in a new post or update this one.

Thank you for your time and may the next step in your journey bring you further success.