Researchers at the University of Colorado Anschutz have identified a critical gap in how post-amputation pain is assessed and treated. This study shows that pain after lower extremity amputation is not a single, uniform condition, but a series of distinct experiences that vary depending on activity level and prosthesis design. These findings could impact care strategies for the approximately 2 million Americans who live with limb loss, and that number is expected to grow in the coming decades.
This research recently PM&Rstudied 83 adults living with unilateral femoral or lower tibial amputations. Participants reported pain at rest and during real-world movements to better reflect their daily challenges.
“Untreated or inappropriately treated pain can severely limit mobility, delay return to work, disrupt sleep, and significantly reduce quality of life. This underscores the urgent need for a more precise and personalized approach to care.” said Daniel Melton, M.D., senior author of the study, professor of physical medicine and rehabilitation, and co-director of Amputation Medicine and Rehabilitation in the Osseointegration and Limb Repair Program at the University of Colorado Anschutz.
There are three types of pain after amputation
This study showed that most participants experienced more than one type of pain. They include:
- phantom limb pain: pain perceived in the missing part of the limb
- residual limb pain: pain in the rest of the limbs
- musculoskeletal pain: Pain in the back, hips, or joints that may occur due to changes in walking ability.
Each pain behaves differently during activity, which explains why combining all pains into one overall score masks important patterns.
Key findings regarding pain and activity
- Musculoskeletal pain is significantly increased during walking and daily activities with a socket prosthesis, suggesting that improved gait and load distribution may help reduce secondary pain.
- Residual limb pain was closely associated with difficulty performing daily tasks and reduced quality of life in participants with traditional socket prostheses, but not in bone-anchored limbs, highlighting the impact of socket pressure on overall health.
- Phantom limb pain showed a more variable pattern and did not increase consistently with activity level, especially in those with osseointegrated prostheses.
Post-amputation pain is not all the same, and differentiating between pain types can help clinicians improve mobility, comfort, and long-term outcomes. Patients are often asked to rate their overall pain using a single number. If you don’t differentiate between them, you may miss the opportunity to treat the real cause of the problem. ”
Dr. Eric J. Earley, Assistant Professor of Orthopedic Surgery, Anschutz University School of Medicine, and lead author of this study
Why prosthesis design is important
The study also compared those using a traditional prosthetic socket to those using a bone-anchored limb (BAL) system. The results showed that pain experiences differ not only in intensity but also in how they respond to activity. For prosthetic socket users, higher levels of physical activity, such as walking, were associated with increased musculoskeletal pain. For people with bony limbs, pain did not increase with activity and was much less tied to overall level of movement. This suggests that the osseointegration design leads to a more consistent pain experience during daily activities compared to the socket system.
By capturing pain across a range of activity intensities, not just at rest, this study highlights that while some socket prosthesis users experience pain that rapidly increases with movement, users with bone-anchored limbs often report stable pain levels regardless of activity. These differences highlight that prosthetic leg design can directly impact comfort during real-world movements and impact mobility, daily function, and quality of life.
Impact on care
This study suggests that clinicians should evaluate each type of pain separately. A more detailed assessment may help guide you below.
- Targeted prosthetic adjustment
- Physical therapy focused on walking
- Treatment specific to phantom limb pain
- Rehabilitation for musculoskeletal strains
“For many patients, pain determines their ability to remain active and independent,” Melton says. “Different pains require different solutions. A more detailed pain assessment can lead to better treatment decisions, leading to improved daily functioning and a better quality of life for people with limb loss.”
For more information, please visit the CU Anschutz Department of Physical Medicine and Rehabilitation and the CU Anschutz Limb Restoration Program.
sauce:
University of Colorado Anschutz
Reference magazines:
Early, E.J. others. (2026). Differences in body pain and increased activity intensity during phantom limb, residual limb, and pain in unilateral lower extremity amputees are recalled. PM&R: Journal of Injury, Function, and Rehabilitation. DOI: 10.1002/pmrj.70096. https://onlinelibrary.wiley.com/doi/abs/10.1002/pmrj.70096
