Avoiding Secondary Pain

Introduction

Key to preventing secondary pain after limb loss is preventing complications. This means taking meticulous care of your residual limb, your prosthesis and your general health.

Because your residual limb is hidden under your prosthesis, paying close attention to how it looks when your prosthesis is off is very important. Developing habits of twice-a-day inspection and care is very important.

Also important is taking care of your prosthesis, liners and socks.

And what is meant by the term “general health”? This means eating well, getting physical exercise and rest and emotional well-being. It also means managing any health conditions as well as possible. If you have diabetes, this means keeping your glucose levels under good control. And it means maintaining a healthy weight, without swings of weight gain or loss.

General Guidelines for Taking Care of Your Residual Limb

It is hard to overstate the importance of taking care of your residual limb. Your healthcare team will give you instructions, but here are some general rules:

• Wash your residual limb twice a day.
• Use mild, fragrance-free soaps, as they are the least likely to cause skin irritation.
• Use water-based lotions rather than alcohol-based, which have a tendency of drying the skin.
• Wash your liner every night.
• Do not wear a wet liner.
• If your amputation is below the knee, check the hard-to-see area behind your residual limb knee with a mirror.
• Report to your prosthetist the development of any blisters or reddened areas (that don’t go away when your prosthesis is off) on your residual limb.

Care for Your Prosthesis

• An ill-fitting prosthesis greatly increases your risk of secondary pain. The socket should be comfortable and practical
• Always wear shoes with the same heel height as the one your prosthesis was aligned with originally to maintain the right alignment.
• You should check your prosthesis frequently for unusual signs of wear and tear and report concerns as soon as possible to your prosthetist.
• Pistoning and perspiration are two conditions that can cause pain in your residual limb.
  • Pistoning: This occurs when the residual limb slips up and down inside the prosthetic socket while walking. This can cause the skin to pull and be damaged. This is generally caused by one of two things: either by trapped air between your residual limb and your socket liner or by weight loss. To prevent trapped air, be sure to put your socket liner on by rolling it on. If you continue to experience pistoning after you have correctly applied your socket liner, contact your prosthetist to have your fit checked. To accommodate weight loss, some sockets can be reduced and/or padded, thicker liners may be used or air bladders may be installed.
  • Perspiration: Sweating is normal but can cause heat rash and abrasions. When sweating occurs, you should immediately remove your prosthesis. Dry your liner and skin before putting your prosthesis on again.

Keep Moving

When a group of people with limb loss was surveyed, nearly 50 percent reported pain in their non-amputated limb and 62 percent reported low back pain. This is because after amputation other muscles and joints have to carry extra stresses and loads. These stresses can cause strain, inflammation and further pain. Additionally, low back and hip pain can increase symptoms of phantom pain.

Your physical therapist can help you design an appropriate exercise program. Regular exercise will help you strengthen and retrain your muscles. Besides walking, a good follow-up program may include back extension strengthening and balance exercises – important for helping to decrease the stresses to your low back and hips. You should try and see your therapist once a year or so for gait evaluation. If you slowly develop poor gait habits, it can cause back and/or hip pain.

Weight Management

Maintaining a healthy weight is important for everyone. It is even more important after your amputation. Even a 5-pound weight gain or loss can make a difference in the fit of your prosthesis.

Eat a well-balanced diet and drink plenty of water. Not only will this help with weight management, but it will also help with maintaining healthy skin.

Report any change in your weight to your healthcare provider and prosthetist.

Emotional Well-Being

Emotional well-being is another important part of preventing secondary pain; this is sometimes referred to as the mind-body-spirit connection. Here are some suggestions for how to decrease pain through focusing on your emotional well-being.

• Practice relaxation. We know that tension and stress increase pain. It is estimated that 50 percent of pain can be reduced by relaxation.
• Do things that you enjoy (e.g., hobbies, movies) with people you enjoy being with. Do something new and different every day.
• Get social support. Stay in contact with friends and family, whether in person or by phone/Internet.

About the Amputee Coalition

The Amputee Coalition is a donor-supported, nonprofit voluntary health organization serving the over 5.6 million people with limb loss and limb difference in the United States.

For more information, please call 888-267-5669 or visit 1a2c2025.com.

Acknowledgements

This project was supported, in part, by grant number 90LLRC0001-01-00, from the Administration for Community Living, U.S. Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.