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Amputation - Complications of amputation

NHS Choices Medical Reference

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There are a number of factors that influence the risk of complications from amputation, such as your age, the type of amputation and your general state of health.

The risk of serious complications is higher in planned amputations than in emergency amputations.

This is because most planned amputations involve the leg and are carried out in older people with a restricted blood supply, who are in a poor state of health and who usually have a chronic (long-term) health condition, such as diabetes. Most emergency amputations involve the arm and are usually carried out in younger people who are often in a good state of health.

Complications from amputation include:

  • heart complications, such as heart attack or heart failure (when the heart has difficulty pumping blood around the body)
  • blood clots (venous thrombosis)
  • infection at the site of the surgery
  • pneumonia (infection of the lungs)
  • further surgery being required

Due to the relatively high risk of complications, a planned amputation is seen as a 'treatment of last resort'. It is only used when there is no other way of preventing life-threatening and serious symptoms, such as gangrene, from developing.

Phantom limb pain

Phantom limb pain is when a person experiences sensations of pain that seem to be coming from the limb that has been amputated.

It is estimated that 50-80% of people develop phantom limb pain after an amputation. The condition is more common in women than men. Phantom limb pain also appears to be more widespread in people who have had an upper limb amputation than in people who have had a lower limb amputation.

The term 'phantom' does not mean that the symptoms of pain are imaginary and all in your head. Phantom limb pain is a very real phenomenon which has been confirmed using brain imaging scans to study how nerve signals are transmitted to the brain.

The symptoms of phantom limb pain can range from mild to severe. Some people have described brief 'flashes' of mild pain, similar to an electric shock, that last for a few seconds. Other people have described constant severe pain.

The causes of phantom limb pain are unclear. There are three main theories:

  • The peripheral theory argues that phantom limb pain may be the result of nerve endings around the stump forming into little clusters, known as neuromas. These may generate abnormal electrical impulses that the brain interprets as pain
  • The spinal theory suggests that the lack of sensory input from the amputated limb causes chemical changes in the central nervous system. This leads to 'confusion' in certain regions of the brain, triggering symptoms of pain
  • The central theory proposes that the brain has a 'memory' of the amputated limb and its associated nerve signals. Therefore, the symptoms of pain are due to the brain trying to recreate this memory but failing because it is not receiving the feedback it was expecting

Treating phantom limb pain

It can be difficult to treat phantom limb pain as the effectiveness of every treatment varies between different people. Several types of treatment may need to be tested.

Medications

Medication which may be prescribed by your doctor to help relieve pain from nerve damage or to attempt to block pain signals include:

Noninvasive therapy

There are several non-invasive techniques which may help relieve phantom limb pain in some people. They include: 

  • applying heat or cold - such as using heat or ice packs, rubs and creams
  • massage - to increase circulation and stimulate muscles
  • acupuncture - needles inserted into the skin at specific points on the body thought to stimulate the nervous system and relieve pain
  • transcutaneous electrical nerve stimulation (TENS) - involves using a small electric device connected to a series of electrodes. The electrodes deliver small electrical impulses to the site of your stump. TENS is thought to work by disrupting the passage of pain signals to the brain and stimulating the release of natural painkilling chemicals known as endorphins

Mental imagery

Research carried out in Liverpool in 2008 found that if people spent 40 minutes imagining using their phantom limb, such as stretching out their 'fingers' or bunching up their 'toes', they experienced a reduction in pain symptoms.

This may be related to the central theory of phantom limb pain (that the brain is looking to receive feedback from the amputated limb) and these mental exercises may provide an effective substitution for this missing feedback.

One technique that can be used is known as mirror visual feedback. This is where a mirror is used to create a reflection of the other limb. Some people find that by doing exercises and moving their other limb it can help to relieve pain from a phantom limb.

You can read more about the recommended treatments for phantom limb pain (PDF, 76kb) on the Limbless Association website.

Psychological impact of amputation

Loss of a limb can have a considerable psychological impact. Many people who have had an amputation report feeling emotions such as grief and bereavement, similar to experiencing the death of a loved one.

Coming to terms with the psychological impact of an amputation is therefore often as important as coping with the physical demands.

Having an amputation can have an intense psychological impact for three main reasons:

  • You have to cope with the loss of sensation from your amputated limb
  • You have to cope with the loss of function from your amputated limb
  • Your sense of body image, and other people's perception of your body image, has changed

It is common to experience negative thoughts and emotions after an amputation. This is especially true in people who had an emergency amputation, as they did not have time to mentally prepare themselves for the effects of surgery.

Common negative emotions and thoughts experienced by people after an amputation include:

  • depression
  • anxiety
  • denial (refusing to accept they need to make changes, such as having physiotherapy, to adapt to life with an amputation)
  • grief (a profound sense of loss and bereavement)
  • feeling suicidal

Talk to your care team about your thoughts and feelings, especially if you are feeling depressed or suicidal. You may require additional treatment, such as antidepressants or counselling, to improve your ability to cope with living with an amputation. 

People who have had an amputation due to trauma (especially members of the armed forces injured while serving in Iraq or Afghanistan) have an increased risk of developing post-traumatic stress disorder (PTSD).

PTSD is when a person experiences a number of unpleasant symptoms after a traumatic event, such as 'reliving' the event and feeling anxious all the time.

Medical Review: July 09, 2012
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