Introduction to Residual Limb Pain
by Jennifer Peterson MA, PT, on Jun 8, 2020 12:31:03 PM
While phantom limb pain is something that the general public is aware of because it’s a strange phenomenon, people often don’t realize that an amputee may feel pain in their residual limb even after the limb heals. Residual limb pain is experienced by at least half of all individuals with an amputation.1 It refers to any pain that is felt in the part of the limb that still exists.
The reasons for residual limb pain vary, as does who experiences residual limb pain, and when. A person who has had a traumatic amputation may experience severe residual limb pain from tissue damage in the weeks following their amputation that should recede with time, healing and treatment. A neuroma, which is a balled-up end of a cut nerve, can also cause localized residual limb pain. A congenital or traumatic amputee may experience residual limb pain due to utilizing poor body mechanics (how a person moves when doing a task) to compensate for not having the ability to grasp or pinch with the injured limb. All individuals with an amputation may experience pain while using a prosthetic device if that device doesn’t fit well, or if they haven’t been taught how to use their prosthetic device correctly. Fitting patients with a comfortable prosthesis and teaching them how to use it is one of our specialties at Arm Dynamics.
While residual limb pain may seem like something you’re “just going to have to put up with,” there is no need to suffer – many people who seek help find relief. All residual limb pain should be reported to your doctor, your prosthetist and your occupational or physical therapist. They can help you diagnose the pain, and make sure it isn’t phantom pain, as those can sometimes occur at the same time2.
You can help your care team diagnose the problem by keeping a brief "pain journal." Note what you were doing at the time of the pain, its location and severity, and how long it lasted (you might find it most convenient to record these via your voice onto your phone to transcribe later). While focusing on pain long-term doesn’t help, it may be initially necessary to figure out how to combat it.
Once you have a diagnosis, you can work with your care team to determine the best treatment options. Your doctor may prescribe medications or a surgical procedure. Your prosthetist may be able to work with you to find a comfortable fit for your prosthetic device – at Arm Dynamics, we have quite a bit of experience helping individuals find a more comfortable fit after they were initially fit elsewhere. An upper extremity therapy specialist can evaluate you to see what physical treatments and/or education may work best. Those treatments may include Graded Motor Imagery, which can involve both visualization and mirror therapy.
At Arm Dynamics, we use both traditional approaches and tools that we have created in-house over the years to optimize each individual’s prosthetic therapy rehabilitation. Traditional therapeutic approaches to pain management include desensitization methods, select exercises, various modalities (heat, ice, electrical stimulation, etc.) and massage. Our in-house tool is called The Comprehensive Arm Prosthesis and Rehabilitation Outcomes Questionnaire (CAPROQ) that, among other things, assesses pain and numbness to help guide your prosthetic rehabilitation.
If you would like more information about how we can help you assess and manage any pain that you experience in your residual limb, please contact us. If you would like to share your successes and challenges with overcoming residual limb pain, please write them in the comment section below for others to learn from.