Multimodal Approaches for Pain Management and Improving Functional Outcomes Following Amputation

Author(s): David Parvizi, Sugeeth Kandikattu, Ramtin Sahafi, Artin Allahverdian, Blake Han, Marcel P Fraix, Devendra K Agrawal

In the United States, limb amputation affects around 2.3 million people, with projected numbers rising due to the higher levels of diabetes and peripheral vascular disease. Amputee patients not only encounter mobility loss but also residual limb pain, psychological stress, and disparities in access to healthcare. This article presents a critical review of the current literature on functional outcomes and pain management for patients who underwent limb amputation. In terms of pharmacological therapies, gabapentinoids and antidepressants provide minimal relief for post amputation pain, whereas surgical techniques including targeted muscle reinnervation and regenerative peripheral nerve interfaces have resulted in much larger improvements in decreasing neuroma-related and phantom limb pain. The non-pharmacological therapies, including mirror therapy, graded motor imagery, and virtual reality are some of the most effective interventions for reduction of phantom limb pain. Functional improvement can be optimized through microprocessor-controlled prosthetics, osseointegration, and early rehabilitation with an emphasis on resistance training, mobility, and psychological support. Newer techniques including neuromodulation and artificial intelligence-enhanced prosthetic control also play a part in rehabilitation; however, evidence is limited due to their novel introduction to the rehabilitation space. Overall, a multidisciplinary and individualized multimodal approach to rehabilitation remains the gold standard to improve pain control, quality of life, and functional restoration.