Residual limb (stump) pain after amputation

After an amputation the surgeon closes the remaining tissue over the bone to form what is often called the stump. Pain in this area is known as residual limb pain or stump pain. It is separate from phantom limb pain, a pain or sensation that appears to come from the amputated part. Both can occur together, and many people find it hard to tell them apart at first.

The NHS explains that the reasons for amputation include severe infection, gangrene often resulting from peripheral arterial disease, complications of diabetes, serious trauma and deformity. Pain after amputation therefore often arrives on top of an existing illness, and pain from the operation site is expected in the first days.

NHS inform lists three main causes: rubbing or sores where the stump touches a prosthetic limb, nerve damage during surgery, and neuromas. A neuroma is a growth of nerve cells that develops after nerve injury. The NHS page on amputation says that if neuromas, described there as thickened nerve tissue, are thought to be causing pain, the affected cluster of nerves may sometimes need to be removed.

Other possibilities include swelling, skin infection and wound-healing problems. The NHS lists slow wound healing and wound infection among complications of amputation. The size of the stump can change as swelling goes down, so a socket that fitted well at first can later rub or press on one point.

The pattern of pain gives clues. Pain that comes on when the prosthesis is worn and eases when it is off points towards fit or skin pressure. Sharp, shooting or electric pain, or pain triggered by light touch, can suggest a nerve cause. A hot, red, tender stump with discharge points to infection.

Both NHS pages advise checking the stump every day. Warm, red and tender skin, discharge of fluid or pus, and increasing swelling are the signs of infection to watch for, and the care team should be contacted if you think a skin infection is developing. A new open sore, a blister or a change in how the limb looks should also be reported rather than left.

• Pain mainly while wearing the prosthesis: think fit and pressure.

• Shooting or electric pain, or pain with light touch: think nerve.

• Heat, redness, swelling or discharge: think infection and seek advice promptly.

• Pain that appears suddenly after months of comfort: ask for a check of the socket.

NHS inform says stump and phantom limb pain will usually improve over time, and that treatments are available to relieve the symptoms. Medicines that may be used include anti-inflammatory painkillers such as ibuprofen, anticonvulsants, antidepressants that work directly on nerves, opioids such as codeine or morphine, corticosteroid and local anaesthetic injections. Which one is chosen depends on the cause and is decided by the clinical team.

Self-help measures listed by NHS inform include checking the fit of the prosthesis, adjusting it so it feels more comfortable, applying heat or cold, massage to increase circulation and stimulate muscles, and acupuncture. Complementary techniques include transcutaneous electrical nerve stimulation (TENS), mental imagery and mirror visual feedback.

Where a neuroma is the cause and other treatment has not helped, the NHS says further surgery may be needed to relieve pain. Tell the team if painkillers are not working: the NHS advises that a larger dose or a stronger painkiller may be needed.

Healthy skin lowers the chance of pain from rubbing. The NHS advises washing the stump gently at least once a day with mild unscented soap and warm water, drying it carefully, washing more often in hot weather, and cleaning the socket regularly. It warns against leaving the stump in water for long periods, since this softens the skin, and suggests unscented moisturiser before bed or when the prosthesis is off.

Some people find socks worn around the stump absorb sweat and reduce irritation. The NHS notes that the number needed may change as swelling reduces. A compression garment helps with swelling and shape and may also reduce phantom pain, according to the NHS amputation page.

Skin desensitisation before a prosthesis is fitted, such as gently tapping the skin with a face cloth, can make wearing it more comfortable. A prosthetist will advise on socket adjustments.

Ongoing pain interacts with mood. NHS inform says losing a limb can have a significant psychological impact and lists depression, anxiety, grief and post-traumatic stress disorder among common experiences, particularly after trauma. It advises speaking to a healthcare professional if your mental health is affected, and says antidepressants or counselling can be arranged.

Rehabilitation matters too. Physiotherapists and occupational therapists plan exercise to maintain mobility and muscle strength, and teach use of a prosthesis. The NHS adds that adjusting to a prosthetic limb takes a lot of energy, and that it is not suitable for everyone, so pain that limits prosthesis use is worth raising early.

If the remaining leg or foot has diabetes or poor circulation, protecting it is just as important. The NHS advises avoiding poorly fitting shoes and getting regular foot reviews.

Contact your amputee or prosthetics team if stump pain is new, is getting worse, stops you wearing your prosthesis, or comes with skin breakdown. Ask for an urgent review, or call NHS 111, if the stump is hot, red, swollen and discharging, or if you have a fever. Call 999 or go to A&E for severe illness, heavy bleeding or sudden severe pain with a cold, pale or blue limb.

Pain services and specialist rehabilitation departments can help when pain persists beyond the usual recovery period. NHS pathways are available in most areas, and private pain and rehabilitation services offer a parallel route, though both rely on a clear assessment of what is causing the pain.