Pain after amputation

Abstract

### Key points Amputation of a limb is one of the oldest recorded surgical procedures. Traumatic amputation and use of a prosthesis is found written in Sanskrit texts dating from 1800 to 3500 BC. Today, amputation remains a commonly performed surgical procedure with ∼5500 lower limb amputations carried out in England alone every year.1 Complications from peripheral vascular disease and diabetes are the leading medical causes of amputation although worldwide a vast number are as a consequence of trauma. Internationally, accurate numbers of limb amputations performed are very difficult to estimate as there is no recognized database or organization collecting this information. Regardless of the indication for surgery, pain management after amputation is challenging. Amputation of a limb is one of the most severe pains in the human experience. This is attributable to the magnitude of the tissue injury involved and the varying loci of centres responsible for pain generation; comprising peripheral, spinal, and cortical regions. Pain after amputation involves nociceptive pain, due to bone and soft tissue injury, and neuropathic pain from direct neural trauma and central sensitization. This leads to a complicated, mixed, form of pain and a highly varied array of different postoperative pain syndromes. The burden of pain after amputation is therefore considerable, not just in the short term, but also in the years and decades after surgery. Severe post-amputation pains from phantom limbs have been recorded in …