The role of peripheral nerve surgery in the treatment of chronic pain associated with amputation stumps

BACKGROUND: Debilitating pain following amputation surgery can seriously affect the long-term success of the operation and the patient's quality of life. Often, such patients are unable to ambulate because of pain when using a prosthesis; become grouped in the chronic pain category; and are treated with high-dose narcotics, antidepressants, or other methods to treat symptoms that may provide little or no relief. Little attention has been given to the role of peripheral nerve surgery as an early treatment option. METHODS: A retrospective review of 21 consecutive amputees with chronic stump pain was performed. The surgical technique included removal of the neuroma with implantation of the proximal nerve ending into adjacent muscle. In addition to the surgical outcome, other variables evaluated included resolution or optimal improvement in pain and spasms, change in quality of life, and ambulation status. RESULTS: The mean duration of stump pain before surgery was 7.28 months (range, 5 to 18 months). After surgery, there were statistically significant changes with pain and spasms, quality-of-life, and ambulation status. The mean follow-up was 22.8 months, and there was no recurrence of neuroma. CONCLUSIONS: Peripheral nerve surgery plays a significant role in the treatment of chronic pain associated with amputation stumps. After conservative treatment methods have been exhausted, a treatment algorithm for peripheral nerve surgery is successful in improving or resolving chronic pain and the quality-of-life issues associated with amputation patients.