Residual limb pain

Diagnosis

To diagnose residual limb pain, a healthcare professional looks for the cause. Some causes can be treated. Tests and procedures used to diagnose residual limb pain may include:

• Physical exam. A healthcare professional feels the residual arm or leg to check for issues in the skin or bones. The healthcare professional also looks for signs of infection and lumps.
• Imaging tests. MRI, CT, X-rays or ultrasound can help rule out other causes for the pain or confirm the diagnosis. These tests may show bone breaks or bruises, tumors, infection, or other bone issues.
• Blood tests. Blood tests may help rule out other causes for the pain or confirm the diagnosis.

Treatment

Treatment for residual limb pain depends on the cause. For some people with residual limb pain, the pain gets better in time without treatment. Treatments for residual limb pain may involve medicines, therapies or procedures.

Medications

• Pain relievers. Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) available without a prescription may help. Some people need stronger, prescription medicines, such as opioids.
• Antidepressants. Tricyclic antidepressants or selective norepinephrine reuptake inhibitors may help with pain that nerve damage causes.
• Anticonvulsants. Gabapentin (Gralise, Neurontin) and pregabalin (Lyrica) may help relieve pain that nerve damage causes. Experts believe these medicines block nerve signals to ease pain.
• N-methyl-D-aspartic acid agonists, also called NMDA agonists. These medicines that you put on the skin, called topical, may include ketamine. They make nerve cells react less to pain. They may ease pain, but the effects don't last long. They also can cause serious side effects.

Therapies

• Physical and occupational therapy. These therapies involve exercises people do before and after removal of an arm or leg, called amputation. The therapies also include fitting a replacement arm or leg, called a prosthesis, and learning how to use it. Wearing garments that put pressure on the residual arm or leg, called compression garments, also may help.
• Massage. Gentle massaging of the arm or leg sometimes can ease pain.
• Hypnosis. A small study found that three sessions of hypnosis eased residual limb pain.

Surgery or other procedures

• Nerve blocks. These shots, called injections, block or turn off a nerve's pain signals. They can help ease residual limb pain. And, if the block works, it may help diagnose a tangle of nerve endings, called a neuroma.
• Neuromodulation. These treatments use electrical impulses, called stimulation, on a nerve to relieve residual limb pain. Treatments may include spinal cord stimulation, also called SCS, peripheral nerve stimulation, also called PNS, and transcutaneous electrical nerve stimulation, also called TENS.
• Osseointegration. This newer procedure connects a replacement arm or leg, called a prosthesis, directly to bone. It may help people who have trouble with a standard prosthesis, including residual limb pain. This procedure is not widely available.

• Regenerative peripheral nerve interface. Also called RPNI, this newer procedure helps prevent neuroma, a tangle of nerve endings that often forms after an amputation. It also helps prevent pain from neuromas that have formed. Neuromas are a major cause of residual limb pain.

  RPNI involves putting the nerve endings into tissue from a muscle graft. The graft often comes from the part of the leg or arm that was removed. This procedure is not widely available.