After amputation of the stump can be painful. Causes include: skin depth infection soft tissue infections (e.g., osteomyelitis, vascular graft infection.) Pressure points with or without skin damage neuroma pain Phantom limb ischemia infection of skin and breakdown have clear, visible manifestations and should be treated. A deep infection can be difficult to diagnose because focal swelling and redness may not be clear until the pain for some time are available; systemic manifestations such as fever or tachycardia may first appear and should not be ignored. A painful neuroma, in each severed nerve occur (by surgery or trauma) and cause focal pain which can be blocked (as a diagnostic maneuvers) by injection of a local anesthetic temporarily. Patients whose amputation was necessary due to ischemic vascular disease are at risk for further ischemia, which can be difficult to diagnose, but a very small transcutaneous O2 voltage (<20 mmHg) on ??the skin of the distal extremity may be an indication. Phantom pain should be considered if medically urgent causes were excluded. If no medical conditions are present that are causing the pain, sometimes helps a massage of the remaining limb to relieve the pain. If a massage is ineffective analgesics can be used. Typically, NSAIDs or acetaminophen can be used, but sometimes opioid analgesics are required. If these measures do not relieve the pain or patients need a longer opioid therapy, a consultation with a pain specialist is required. For the treatment if necessary mechanical devices include (for. Example, a vibrator), ultrasound, and medications such as antidepressants (such. As nortriptyline, desipramine) and anticonvulsants (eg. B. gabapentin). Sometimes pain in other limbs or hips occur in the spine, shoulders or neck. This pain can occur because wearing a prosthesis altered or causes them to repeat certain movements constantly posture and gait of patients. Regular stretching and strengthening exercises can help to relieve this type of pain. A physical therapist can also design an appropriate training program. Phantom pain Many patients experience at some point phantom pain. The Phantom aspect is not the pain that is real, but the source of pain - in a limb that has been amputated. Phantom pain is more likely if the pain before the amputation were strong and lasted a long time. In some cases, the pain, depending on the mechanism of amputation, severe (for example, traumatic amputation vs elective surgical removal). Phantom pain is often severe shortly after the amputation, and then decreases with time. Therapies for postoperative desensitization are available and are recommended to reduce pain during the initial weight load in the prosthesis. Phantom pain occurs for many patients more often then when the prosthesis is not worn (because the limb and the interface have no contact), for example. As at night. The risk of having this pain when spinal anesthesia and general anesthesia is used during the operation is reduced. There are a number of other, non-pharmacological therapies that can be added to the treatment plan, including transcutaneous electrical nerve stimulation (TENS), acupuncture and spinal cord stimulation. Phantom Sensation Most patients also experience a phantom sensation that feels like it, that the amputated limb is still there. Phantom sensation can be painful during the immediate postoperative period. However, the pain in most amputations seems to disappear. Phantom pain in amputees newly can be a problem, especially at night when they go to the bathroom and believe that her leg is still there and they do not remember to put their prosthesis. Many recommend prosthetist that a protective device should be worn during sleep to protect the amputees from injury.

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