Date: 06 Oct 2009

The vexing problem of post-amputation pain: What is the optimal perioperative pain management for below-knee amputation?

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Phantom pain, defined as intense throbbing or burning pain in the missing distal limb, is a common affliction after amputation. First described in 1872 by Ambroise Paré, the phenomenon is a common occurrence in 60–80% of amputees.1 Although some reports suggest abatement of phantom pain after a few years, others affirm it is long-lasting. In addition to phantom pain, the unfortunate patient may also experience pain in the residual leg (stump pain) for reasons such as osteomyelitis, excessive scar tissue, or neuroma formation. In numerous pharmacotherapy trials, opioids, ketamine, anticonvulsants, and tricyclic antidepressants have provided only inconsistent relief.

Intense pre-amputation pain is likely to be associated with the development of long-term phantom pain.2 In the 1970s, this observation led researchers to hypothesize that pain created a permanent imprint in the dorsal horn and in the pain-processing regions of the central nervous system. A number of investigations were undert