Después de la amputación de la pierna

Para iniciar la rehabilitación:

• Usted debe tener poco o ningún dolor en el muñón residual

• Su muñón residual debe ser capaz de soportar peso

• La hinchazón y la retención de agua deberían haber disminuido y estabilizado

• Usted debe ser capaz de mover su muñón residual tanto como sea posible en todas las direcciones

Su situación personal determinará cuánto tiempo le llevará llegar a este punto. Sin embargo, usted puede promover la curación trabajando activamente hacia ella. Si bien esto a menudo requiere paciencia y mucha resistencia, vale la pena: cuanto más móvil sea cuando comience la rehabilitación, antes se le podrá colocar una prótesis.

Recomendamos que durante este tiempo después de la amputación en el hospital para elegir un centro de tratamiento ortoprotésico adecuado para su fase de rehabilitación en colaboración con su técnico ortopédico. Nuestra lista de expertos le ayudará a encontrar instalaciones que se especialicen en trabajar con amputados.

Experts have various theories regarding the origin of phantom pain. One of the most common ones is that different areas in the brain are responsible for different body regions. When a body part is missing and doesn’t produce any feedback anymore, the brain interprets this lack of a signal as pain. In this context, it’s interesting to note that people with a congenital limb difference, known as dysmelia, do not experience phantom pain as often. This suggests that there is a sort of “learning effect” in the brain. Pain memory appears to play an important role as well. If the patient was already experiencing pain before the amputation, this can affect the development of phantom pain and should also be taken into account in selecting the therapy.

Phantom pain is very individual and depends on many factors. It affects individuals with leg or arm amputations equally. The pain may be triggered or intensified by certain types of weather, exposure to cold temperatures or emotional stress. It may occur only at certain times, gradually decrease or increase, or always be present. The type, intensity and characteristics of the pain can differ as well. Affected individuals describe pulling and piercing or burning and cramp-like pain.

Phantom pain is different from phantom sensations, feelings in the lost limb that are not painful.

Various kinds of pain may occur in the residual limb after an amputation. It is important to differentiate between residual limb pain and phantom pain, since these types of pain are treated differently.

There are many different therapy approaches for both types of pain. Combining several types of therapy is recommended for phantom pain. There is no standard therapy that helps all affected individuals. Furthermore, many therapies are of a long-term nature and require the active participation of the affected person. You may need a great deal of patience and endurance. But we can only encourage you to do the therapy, even if it is challenging. Be sure to talk to your doctor, O&P professional and therapist. They will work closely with you and support you to the best of their ability. The following methods are suitable means of therapy for phantom pain after an amputation and complement each other

• Mirror therapy: sitting in front of a mirror, the patient’s sound limb is reflected with the help of mirrors. This makes it appear as though the amputated limb is there again. Known as the phantom limb, it can now be moved purposely via the sound side and therefore influenced. This makes it possible to release the phantom limb from cramped and painful positions with the help of movements by the sound side, moving it into a more comfortable, pain-free position. Comparable results can be obtained by looking at photographs (known as lateralisation training). This is intended to practise right/left memory.

• Sensorimotor therapy: massaging the residual limb with various materials stimulates nerves via the skin. Ultrasound, thermal or electrotherapy can be used here as well.

• Wearing a prosthesis or liner: for many affected individuals, pain is alleviated by wearing a prosthesis or liner. This may be due to sensory stimulation of the residual limb as well as the idea that, with a prosthesis, the body part is still there so the brain is receiving corresponding feedback.

• Pain therapy: a pain therapist is a doctor specialising in the treatment of pain. Your doctor will put you in contact with such a specialist. It’s important that you do not try to treat yourself with pain medication in any case.

Residual limb pain and phantom pain are different types of pain and are therefore treated differently. For this reason, it’s important that you are thoroughly examined in order to determine whether you are experiencing phantom pain or another form of residual limb pain. Residual limb pain can also be caused by a poorly fitting prosthesis. Medical examinations help clarify whether you may have bothersome scar tissue, painful residual limb neuromas, inadequate soft tissue coverage or excess soft tissue. These causes of pain can be eliminated on a long-term basis by adapting the components or via another surgical intervention.

Certain operating techniques can also help reduce residual limb pain and especially the pain originating from some nerves in the residual limb after the amputation. If possible, preventive pain therapy should commence during the operation with a local anaesthetic or begin directly after the operation to prevent the onset of pain or the development of chronic pain.