Stump and phantom limb pain.

Recent literature suggests that phantom pain and stump pain have closely related physiologic mechanisms and that treatments frequently overlap. Decreased blood flow in the residual limb is related to burning and tingling phantom and stump pain, whereas spasms in major muscles of the residual limb precede cramping phantom and stump pain. There is little support for psychological mechanisms underlying the vast majority of chronic phantom and stump pain problems, but these mechanisms can exacerbate both acute and chronic pain. It is critically important to educate patients about the process of amputation and the physiologic mechanisms of phantom sensation and pain in order to minimize magnification of pain due to stress. Acute stump pain usually responds well to traditional interventions based on identifying and correcting specific problems in the residual limb. Most traditional treatments for phantom pain and chronic stump pain are not effective for more than a few months. Recommended treatments are related to underlying mechanisms. For chronic phantom and stump pain, burning sensations are treated with interventions designed to increase blood flow to the residual limb, whereas cramping sensations are treated with interventions that reduce muscle spasms.