Acute Care

Pain Management

Pain can have a significant impact of the well being and rehabilitation outcome of an amputee. There can be many causes of pain, and just as many treatment modalities and options. Pain can occur in the pre-operative period, post-operative, and also long term during and after rehabilitation. The main types of pain include:

  • Vascular pain
    • Exercise induced claudication
    • Pain caused by vascular disease - painful ulcers, early stage gangrene, or diseased / infected tissue
  • Orthopaedic / musculoskeletal pain
    • Pain from other injuries suffered during a traumatic amputation
    • Musculoskeletal pain caused by abnormal gait patterns
    • Arthritic pain caused by normal ageing processes, or excessive wear and tear on the joints and soft tissue of the residual limb or intact limb
  • Post-surgical pain
    • Pain at the site of the surgical wound
    • Ongoing ischaemic pain
    • Pain caused by ill-fitting rigid dressings
  • Stump pain
    • Neuromas
    • Bone growth / bone spurs
    • Ischaemic / claudication pain
    • Adherent scar tissue
    • Infection
  • Phantom pain
  • Neuropathic / nerve pain
  • Prosthetic-caused pain
    • Ill-fitting socket - lack of distal contact, insufficient bony relief, too tight, too loose, pistoning causing friction / blisters
    • Incorrect alignment and pressure distribution
    • Incorrectly donned prosthesis, including the number / thickness of socks
    • Excessive sweating / skin breakdown
    • Verrucous hyperplasia
  • Pain from comorbidities
    • Cardiac
    • Vascular
    • Recurrence of tumours
    • Musculoskeletal

Pain Treatment

A discussion of all pain treatment modalities is beyond the scope of this page, however some of the common options are listed. Many of these options can be used to treat more than one of the causes listed above.

  • Pharmacological
    • Sufficient post-operative analgesia
    • Anti-inflammatories
    • Anti-convulsants
    • Opioids
    • Local anaesthetics
    • Nerve blocks
  • Electrophysical - although beware contraindications!
    • TENS
    • Laser
    • Ultrasound
    • Heat (on musculoskeletal causes)
  • Prosthetic
    • Correction of socket fit
    • Alteration of alignment
    • New prescription / prosthesis
    • Trials of different components: silicon / urethane liners, suspension methods
    • Move weight bearing surfaces proximally: thigh-lacers, ischial bearing prostheses
  • Physiotherapy
    • Correction of gait abnormalities
    • Reduction of contractures
    • Physical treatment of musculoskeletal comorbidities
    • Education on donning prosthesis, and monitoring fit over time
    • Cardiovascular / fitness / strengthening programs
    • Early mobilisation
  • Stump Management
    • Reduce / limit stump oedema: bandages / shrinkers, intermittent pneumatic compression therapy, elevation, massage, rigid dressings
    • Massage to reduce / mobilise adherent scars and tissue
    • Massage, rubbing, and other physical modalities to improve desensitisation
  • Other modalities
    • Acupuncture
    • Distraction
    • Mirror box therapy
    • Hypnosis
    • Vibration therapy
    • Cognitive behavioural therapy
    • Improvements in stump hygiene
  • Surgical
    • Stump revision
    • Surgical removal of spurs
    • Insertion of intrathecal pumps
    • Sympathectomy

Helpful Links and References

If you come across any other useful resources, please share them by sending an email to support@austpar.com