Stump Pain

This chapter discusses stump pain or residual limb pain, which arises from the distal end of the stump after amputation. The initial phase, which lasts for 6 weeks, manifests as nociceptive pain that may be followed by neuropathic pain. In 5%–10% of patients with stump pain, the pain evolves to become predominantly neuropathic. In addition, stump pain can be arthrogenic, osteogenic, or infectious. History and physical examination are important in order to determine the origin of pain. Residual persistent ischemia of the stump should be ruled out. The stump should be examined and investigated to rule out the presence of a neuroma. Occasionally, radicular pain, which arises from the lumbosacral levels, presents as stump pain. The most effective management of stump pain is multidisciplinary and multimodal. Acute stump pain is treated with either epidural analgesia or, more commonly, peripheral nerve blocks. Chronic neuropathic pain is treated with antiepileptics such as gabapentin or pregabalin and NMDA receptor antagonists. Transcutaneous electrical nerve stimulation, spinal cord stimulation, and peripheral nerve stimulation play a limited role in management of stump pain. Neuromas are treated with radiofrequency ablation, cryoablation, or coblation. Surgery is the least successful modality to treat neuroma.