Amputees can have pain after the initial injury has healed. Chiropractic and massage therapy can assist patients with chronic issues.
About Amputation
Amputation refers to the removal of an extremity or limb. Doctors can surgically remove toes, fingers, hands, feet, arms, or legs. The most common form of amputation involves the leg, either below or above the knee. Amputation can be performed when there is poor circulation, such as from PAD (peripheral arterial disease), when there is a severe injury, due to a cancerous tumor, because of frostbite or a serious infection, or as a result of a neuroma (thickened nerve tissue). When the surgery is performed, patients may be given either spinal anesthesia or general anesthesia. Hospital recovery time can take at least a week or two. Doctors work to leave the healthy tissue while taking care to remove all of the damaged tissue. Crushed bone and diseased tissue are removed, and uneven areas of the bone are smoothed out. Nerves and blood vessels are then sealed off. Next, the muscles are cut and shaped so that the “stump” can be prepared for prosthesis, or artificial limb. In a closed amputation, surgeons close the wound immediately. Sometimes the skin flaps are left open in case further tissue will need to be removed. Sterile dressings are applied, and then patients are taught how to care for the wound. Doctors prescribe medications to help prevent infection and to provide pain management. Physical therapy, including stretching exercises, as well as practice with the artificial limb, occurs after the surgery.1
Post-Amputation Problems
Younger people in better health fare better from emergency amputations than older people in poor health (with diabetes, for example) who plan their amputations. Complications from the amputations can include blood clots, infection, pneumonia, and heart problems.2 Even though the physical wound from amputation can heal in a month or two, there could be psychological adjustment that lasts longer. Grief over the loss of the limb and body image issues may persist. Amputees need to learn how to cope with their prosthesis, and they may have “phantom pain” in the lost limb. It takes time to regain control and strength in the muscles.3 Phantom limb pain occurs in 50-80% of amputees. It is more common after an upper limb amputation. The pain is real and not imagined. Nerve endings in the stump may develop neuromas, sensory input may cause confusion in the brain, or the brain itself may have a “memory of the amputated limb”.4
Medical and Alternative Treatments
To treat post-amputation pain and phantom limb pain, opioids, antidepressants, and anticonvulsants could be prescribed. Patients can practice, with mental imagery, clenching or stretching their missing limb, and mirror visual feedback can also be effective, where a “mirror is used to create a reflection of the other limb”. In doing so, patients can perform exercises with the other limb to help relieve pain in the missing one. Other non-medication treatments include applying heat, cold, or cream, as well as acupuncture, massage (for circulation and muscle stimulation), and transcutaneous electrical never stimulation (TENS) to help the brain release endorphins.5 Chiropractors could help treat amputees, and they have even worked with Paralympic athletes to improve their performance.6 Massage therapists also work with athletes by providing Deep Tissue Sports Massage.7
References:
1,3 http://www.webmd.com/a-to-z-guides/definition-amputation
2,4,5 http://www.webmd.boots.com/a-to-z-guides/tc/amputation-complications-of-amputation
6 http://www.georgia-clinic.com/blog/2013/09/american-paralympic-medalist-allison-jones-and-chiropractic/
7 http://www.back2best.com/Sportsmassage.html
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