Each year, approximately 185,000 Americans undergo amputation of a limb. The Amputee Coalition estimates that nearly 2 million people in this country are living with the absence or loss of a limb. Amputees face a number of pain issues from phantom limb pain, to pain from prosthetic devices and chronic low-back pain.
Peripheral arterial disease (PAD) is the leading cause of amputation in people age 50 and older. In PAD, the blood vessels in limbs become damaged because of hardening of the arteries or diabetes.
If blood vessels are unable to supply blood and oxygen to your fingers or toes, the cells and tissues die and are vulnerable to infection. If the blood supply cannot be improved sufficiently or if the tissue is beyond salvage, extensive tissue death may require amputation, especially if a person is experiencing severe pain or infection. In the year after major limb amputation, between 50 and 80% of patients will experience significant pain.
Phantom limb pain highlights the differences between two major kinds of pain. The first is pain related to a distinct injury or disease, which stimulates specific receptors and spinal pathways to the brain. The second is severe chronic pain, which is usually out of proportion to an injury or other underlying condition and persists long after healing is complete. The evidence that excruciating pain may be felt in the phantom half of the body after a total break in the spinal cord tells us that the brain does more than detect and analyze sensory inputs; it creates perceptual experience even in the absence of external inputs. We do not need a body to feel a body or a physical injury to feel pain.
An amputee’s social support network has also been shown to affect pain levels. Research has found that one month after amputation, greater levels of perceived social support were related to lower levels of pain and greater levels of life satisfaction and mobility. In addition, greater social integration was associated with greater occupation function.
The fact that persons with greater perceived social support reported less pain and greater satisfaction with life may suggest that facilitating, enhancing, or providing quality social support immediately after the amputation may affect well-being by distracting the individual from pain and focusing attention on more positive, satisfying aspects of life.
Phantom pain (pain in the part of the limb that is missing) was reported by 80% of the amputees.
- Among those living with limb loss, the main causes are:
- vascular disease (54%) – including diabetes and peripheral arterial disease,
- trauma (45%),
- cancer (less than 2%).
- A separate study showed that six months post amputation surgery, 78.8% of amputees experienced phantom limb pain and 51.2% experienced stump pain (pain where the limb was severed).
Six months post amputation surgery, 78.8% of amputees experienced phantom limb pain and 51.2% experienced stump pain.
In another study, above the knee amputees (transfemoral) were more likely to suffer from back pain (81%) than below the knee (transtibial) amputees (62%). Of those suffering from severe back pain, 89% and 81% also suffered from severe pain in the phantom limb and severe stump pain, respectively.
- The site of amputation is also related to residual pain, with upper-limb amputees reporting more phantom limb pain for longer duration than lower-limb amputees. In both upper and lower- limb amputees, the pain did fade over time.
- “Synaesthesia” for pain is a phenomenon where a person experiences pain when observing or imagining another in pain. Anecdotal reports of this type of experience have most commonly occurred in individuals who have lost a limb. Distinct from phantom pain, synaesthesia for pain is triggered specifically in response to pain in another. One investigation into synaesthesia for pain in amputees found that 16.2% reported that observing or imagining pain in another person triggers their phantom pain.10
- However, one small study has found that depression and anxiety are not more common in phantom limb pain patients, whereas they are more prevalent in subjects with non-phantom chronic pain.11
- A reported 1,558 major amputations have occurred across all military service organizations from Operation New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom. A major limb amputation includes the loss of one or more limbs, the loss of one or more partial limbs, or the loss of one or more full or partial hand or foot.”12
- One study using ultrasound to determine the cause of pain in the residual limbs of amputees found that neuromas were the most frequently found lesions, followed by inflammatory edema, soft-tissue calcifications, bony spurs, soft-tissue infection, overuse injuries, bursae, and skin lesions.