50-95% of amputees suffer from chronic pain after amputation. Causes of pain after amputation include phantom limb pain, residual limb pain (RLP), contralateral limb pain, and back pain (Buchheit et al. 2016; Ephraim et al., 2005).As the etiology of those different pain qualities determines the therapy, a precise medical history and refined diagnostics are required. The cooperation of a multidisciplinary team – orthopedic surgeons, plastic surgeons, CPO, OTs and engineers in an outpatient clinic allow for a comprehensive analysis and approach to this complex symptom.
A systematic algorithm based on this interdisciplinary management of amputees with chronic pain revealed that revision surgery plays a significant role in the treatment of residual limb pain. The algorithm helps to identify underlying pathologies of residual limb pain.
According to this algorithm surgical revisions are indicated for the treatment of residual limb pain if a clear pathology can be identified and after conservative treatment options have been exhausted. Significant research efforts, following surgical refinements as targeted muscle reinnervation, osseointegration and further innovative microsurgical techniques revealed new options for the treatment of residual limb pain. If there is no obvious pathology, it is advisable to avoid surgical revision of the residual limb and treat diffuse pain similar to phantom limb pain in cooperation with a specialized pain therapist and new technologies as virtual reality.
The comprehensive approach by an interdisciplinary management together with new prosthetic technologies and surgical refinements finally offers new dimensions for the prosthetic fitting and rehabilitation of amputees with residual limb pain.
Statement of the objective / learning objectives
The IC informs about innovations and treatment options of RLP. An structured algorithm developped by medical doctors, CPOs and OTs gives hands on a interdisciplinary management of RLP