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Stump and neuroma injections

Pain after amputation can arise from the residual limb, from a neuroma where a cut nerve has formed a sensitive bundle, or as phantom sensation in the missing limb. Targeted injection can help identify which is involved and reduce pain from a symptomatic neuroma.

Pain after amputation is common and is frequently treated as a single problem when it is usually several. Separating them changes what will help.

Residual limb pain is felt in the remaining limb itself and may relate to the bone end, scar, soft tissue, socket fit or load. Neuroma pain arises where a divided nerve forms a bundle of regenerating fibres that becomes mechanically and chemically sensitive; it is typically sharp, electric, and reproducible by pressing one specific spot. Phantom limb pain is felt in the part of the limb that is no longer there, and is generated by changes in the nervous system rather than by local tissue.

Dr Martin's background here. Amputation-related pain sits at the intersection of pain medicine and rehabilitation medicine. His rehabilitation training included amputee care, and this is an area of specific interest.

Finding a neuroma. A symptomatic neuroma can usually be identified on ultrasound and confirmed by pressing on it under vision to reproduce the pain. A small injection of local anaesthetic around it should abolish that pain temporarily — which both confirms the diagnosis and indicates whether targeting it further is worthwhile.

Treatment options. Where a neuroma is confirmed, options include injection with anti-inflammatory medication, radiofrequency treatment, or referral for surgical opinion in selected cases. Where phantom limb pain predominates, injections are less useful and treatment focuses on medication, sensory and mirror-based rehabilitation approaches, and desensitisation.

Prosthetic fit. A poorly fitting socket generates pain that no injection will fix. Assessment includes whether the prosthesis is contributing, and liaison with your prosthetist where it is.

On the day. Ultrasound-guided injections take 10–20 minutes and do not usually require sedation. You go home the same day.

Risks. Whilst pain procedures are generally safe and well tolerated, all procedures carry risks. The specific risks relevant to you and your procedure will be discussed with you, and written information provided, before you decide to proceed.

Realistic expectations. Pain after amputation often has more than one generator, and treating one may only partly reduce the total. Dr Martin will be clear about what a given step is likely to achieve.