Key Learning Points

• The present chapter focuses on clinical characteristics, mechanisms, treatment, and possible preventive measures for pain after limb amputation.

• The incidence of phantom pain, i.e. pain referred to the missing limb, is 60-80 percent. The number of amputees with severe phantom pain is substantially smaller and in the range of 10-15 percent.

• Phantom sensations, i.e. nonpainful sensations referred to the missing limb, are experienced by almost all amputees, but rarely pose any clinical problem.

• Pain located to the residual limb is frequent immediately after amputation. Residual limb pain, however, persists in 5-10 percent of amputees and is often associated with sensory abnormalities, such as hypoesthesia, hyperalgesia, or allodynia.

• The mechanisms underlying chronic pain in amputees are not fully known, but both peripheral and central mechanisms are involved.

• Chronic residual limb and phantom pain are difficult to treat. Treatment regimens used for other neuropathic pain conditions are probably the best approximation.

• It is not possible to prevent all postamputation pain from developing even by intense perioperative pain management.

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