Researchers at the University of Colorado Anschutz identified a critical gap in how post-amputation pain is evaluated and treated. Their study showed that pain after lower-limb amputation is not a single uniform condition but a set of distinct experiences that change depending on activity level and prosthetic design.
The research examined 83 adults living with unilateral transfemoral or transtibial amputations who reported their pain at rest and during real-world movement to better reflect daily challenges.
“Untreated or improperly treated pain can severely limit mobility, delay return to work, disrupt sleep, and significantly diminish quality of life. This underscores the urgent need for a more precise, personalized approach to care,” said Danielle Melton, MD, senior author of the study, professor of physical medicine and rehabilitation, codirector of amputation medicine and rehabilitation for the Osseointegration and Limb Restoration Program at the University of Colorado Anschutz.
The study showed most participants experienced phantom limb pain, residual limb pain, and musculoskeletal pain that can develop due to changes in walking mechanics. Each pain behaved differently during activity, showing why combining all pain into a single overall score can mask important patterns.
Musculoskeletal pain increased significantly during walking and daily movement with socket prostheses, suggesting improvements in gait and load distribution may help alleviate secondary pain.
Residual limb pain was closely associated with challenges completing daily tasks and reduced quality of life in participants using traditional socket prostheses, but not bone-anchored prostheses, highlighting the impact of socket pressure on overall well-being.
Phantom limb pain showed a more variable pattern and did not consistently increase with activity, particularly in individuals using osseointegrated prostheses.
“Not all post-amputation pain is the same, and separating pain types could aid clinicians to improve mobility, comfort, and long-term outcomes,” said Eric J. Earley, PhD, assistant research professor of orthopedics at the CU Anschutz School of Medicine and lead author of the study. “Too often, patients are asked to rate their overall pain with a single number. If we don’t distinguish between them, we may miss opportunities to treat the real source of the problem.”
The study also compared people using traditional socket prostheses with those using bone-anchored limb systems. It found that pain experiences differ not just in intensity but in how they respond to activity. For users of socket prostheses, higher levels of physical activity, such as walking, were linked with increased musculoskeletal pain. For those with bone-anchored prostheses, pain did not increase with activity and was far less tied to movement level overall. This suggests that the osseointegrated design leads to a more consistent pain experience during everyday activities compared to socket systems.
By capturing pain not just at rest but across different activity intensities, the study highlighted that some socket prosthesis users experience pain that spikes with movement, while those with bone-anchored limb systems often reported stable pain levels regardless of activity. The differences underscored how prosthetic design can directly influence comfort during real-world movement, with implications for mobility, daily function and quality of life, according to the study.
The study’s authors suggested that a more detailed clinical assessment may help guide targeted prosthetic adjustments, gait-focused physical therapy, treatments specific to phantom limb pain, and rehabilitation for musculoskeletal strain.
“For many patients, pain determines whether they can stay active and independent,” said Melton. “Different pains require different solutions. More detailed pain assessment may lead to better treatment decisions and improved daily functioning for people living with limb loss giving them a better quality of life.”
The study, “Differences in phantom limb, residual limb, and bodily pain during pain recall and increasing activity intensity in persons with unilateral lower limb amputation,” was published in PM&R.
