Download Pain management after amputation

Pain management after
amputation
Information for patients
Integrated Pain Services
Pain following amputation is usual but can be treated. The aim of this leaflet is
to outline the types of pain you may experience and explain the different drugs
you may be prescribed.
Types of pain
Your nursing or medical staff may ask you to describe your pain. This may
seem like a difficult question but it can help us decide which medications may
help you. The different pains you may experience can be split into two groups:
Stump pain
This is pain felt at the site of your wound and around the end of your stump.
This is often described as a sharp, throbbing or hot pain. This is usually fairly
easy to treat.
Phantom pain
Your brain is not used to your limb not being there. Even though the nerves in
your limb have been cut, they still send messages to your brain as if your leg or
arm were still there. Feeling in an absent limb is called phantom sensation
and this should lessen over time as your brain gets used to your limb not being
there. Phantom sensations can be annoying and frustrating so please report
these to staff.
If the sensations in your missing limb are painful, this is termed phantom limb
pain. It is difficult to think that a leg or arm that is no longer there can be painful
but this is not unusual. Phantom limb pain can be a little more difficult to treat
than stump pain but there are things that may help.
After your operation you may have one or more of these drugs prescribed. The
following information may help you to understand the mix of tablets you are
given. If you are unsure about any of your medications please ask.
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Common Medications Post Amputation
Nerve Catheter
Most patients will have a nerve catheter infusion following amputation. This is a
thin tube which is threaded next to the nerve (inside your limb/ wound) to deliver
local anaesthetic to numb the nerve. The tube is connected to a little ball that
looks like a balloon and will deflate over time as the liquid anaesthetic is
delivered. If you notice any wetness inform the staff – this could be leaking. If
you notice the balloon has completely deflated, inform the staff.
Picture of nerve catheter:
Opioids
Opioids are Morphine type drugs. You may be prescribed these after surgery,
either to be taken by mouth (for example, Oramorph, MST, Oxycontin,
Tramadol) or through a vein (Morphine patient controlled analgesia pump).
This group of drugs work best on stump/wound pain (rather than phantom pain).
They may make you feel a bit sick, sleepy or muddled. Tell the staff whether or
not they help and if they give you any side effects.
Gabapentin/Pregabalin
Gabapentin and Pregabalin are anti-epileptic drugs that can be used to treat
pain caused by damage to nerves (neuropathic pain). The dose of these drugs
needs to be gradually increased over a period of time to reduce the risk of side
effects.
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Side effects may include dizziness, dry mouth, tiredness, visual disturbance,
loss of balance, muscle weakness, gastric discomfort, weight increase,
tremor/shakiness, severe headache and drowsiness. Some of these side
effects wear off over time and it is worthwhile persisting if you can. If they are
unbearable, the dose can be reduced.
Salmon Calcitonin
Salmon Calcitonin is a protein that has been shown to reduce a range of nerve
type (neuropathic) pains including phantom limb pain.
It is given as a short course (5 days) of injections just under the skin.
Side effects are rare but may include nausea, vomiting, diarrhoea, abdominal
pain, flushing, dizziness, headache, taste disturbances and musculoskeletal
pain. If you experience any side effects, please report them to staff.
Ketamine
Ketamine is an anaesthetic drug that also acts as a painkiller. It is very useful
where there is a mixture of wound and nerve (neuropathic) pain and is usually
given through the drip in your arm. We use very low doses on the ward that
may alleviate pain but will not anaesthetise you. You may feel a little sleepy or
have funny dreams – please tell the staff if this happens and we can lower the
dose or stop the infusion.
Memantine
Memantine works in a similar manner to Ketamine but is given as a tablet. It is
also sometimes used for the treatment of dementia but this is not why you have
been prescribed it. Like Ketamine, it works well where there is a mix of wound
and nerve type pain.
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You have been prescribed:
Please
tick
Details (duration etc)
Nerve catheter
(local anaesthetic)
Opioids
Gabapentin
Pregabalin
Salmon Calcitonin
Ketamine
Memantine
Continue to take these medicines unless advised by your Doctor or Pain
Specialist – it is important to reduce doses gradually rather than stopping
suddenly.
Please let staff know if the medications given are helping the pain. Do not be
afraid to say they are not! Tell the staff if you are getting any side effects.
You are the best person to tell us about your pain!
If you have any questions ask
Developed by Pain Specialist Nurse and has been reviewed by other staff and patients
Reviewed: 10/2015 Review: 10/2017 LN0967
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