There are 3 areas of pain:
1) Intrinsic Pain - The pain following the amputation surgery
2) Phantom Pain - Pain that you feel in the portion of your limb that has been removed
3) Extrinsic Pain - Pain when using a prosthesis or pain that you experience by bumping your limb or falling, etc.
Today I'm touching briefly on extrinsic pain.
First, I want to emphasize this fact:
I believe that no amputee should experience pain as a natural consequence of having an amputation.If the surgery is done as best it can, and if the prosthesis is fit as best it can, you should experience no pain.
Extrinsic pain is typically is from the prosthesis.
When you have a prosthesis and your limb is encased in a socket (the receptacle into which your limb goes), and when you put your weight down, that load is transferred somehow to your limb.
If the socket is designed correctly and as intimately as possible you should feel no pain. You'll feel pressure, but it won't be painful.
However if you do feel pain, the prosthetist must evaluate that and determine what to do. There are a number of solutions.
If it's a bone - a very prominent bony area - we can make a little relief by removing material so there is less pressure; or we increase pressure adjacent on either side, or around it, to increase pressure thereby relieving pressure over that particular spot.
If you have no pain standing but when you start performing activities - basketball, frisbee, jogging, running, bicycling, in the gym working out, etc. - and you experience pain based on the forces when you're doing those activities, that requires additional refinement of socket design, so that you don't experience those pressures that result in pain.
So you must work with your prosthetist and explain exactly:
- WHAT you feel
- WHERE you feel it
- WHEN you feel it
- MAGNITUDE of pain (using the Mankoski scale or a similar 10-point scale)
For example, if you intend to run a mile but can only make it a couple hundred feet due to pain, you should absolutely see your prosthetist and have them do something about it.
My experience and our experience here has been that people do not experience pain when they have their prosthesis on and when they are carrying on their daily activities, whatever they are; whether it's just walking, going to the gym, or performing some sports or recreational activity.
In fact there are a number of people who run long runs like marathons & 50-mile runs without skin sores, without pain, and without skin breakdown.
The process of fitting is very complex, there are many procedures; and we go through all of these procedures so that the prosthesis and the fitting will last as long as possible.
We have patients that have been wearing the same prosthesis for 15-20 years. That's well past the average of 3-5 years.
It's important that, as an amputee, you have the patience to go through each of these steps, so you don't have to visit your prosthetist any more than necessary.