A new study from researchers at the University of Colorado Anschutz is challenging the way clinicians understand pain after limb loss, and it could reshape how care is delivered for millions of amputees.
Published this year in PM&R: The Journal of Injury, Function, and Rehabilitation, the study argues that post-amputation pain should no longer be treated as a single condition. Instead, researchers found that different types of pain behave differently depending on movement and prosthetic design.
The research, led by Eric J. Earley, PhD, and senior author Danielle Melton, MD, examined 83 adults living with unilateral lower-limb amputations. Participants reported pain levels both at rest and during real-world movement, a distinction researchers say has often been overlooked in traditional evaluations.
Researchers focused on three common categories of post-amputation pain: phantom limb pain, residual limb pain, and musculoskeletal pain, which can include back, hip, and joint discomfort caused by changes in walking mechanics. What they discovered was that each type of pain responded differently during activity.
For participants using traditional socket prostheses, musculoskeletal pain often increased during walking and daily movement. Researchers suggested that factors such as gait mechanics and uneven load distribution may contribute to secondary pain over time. Residual limb pain also appeared to have a significant impact on quality of life for socket users, particularly when it came to completing everyday tasks. Phantom limb pain, meanwhile, behaved less predictably and did not consistently increase with movement.
The study also compared traditional socket prostheses with bone-anchored limb systems, also known as osseointegrated prostheses. Researchers found that participants using bone-anchored limbs generally reported more stable pain levels during activity, while socket users were more likely to experience pain spikes during movement.
“Not all post-amputation pain is the same,” Earley said in a release accompanying the study, noting that reducing all pain to a single numerical score may prevent clinicians from identifying the true source of discomfort.
For clinicians and patients alike, the findings point toward a more personalized future in limb-loss care—one where pain assessments are more nuanced and treatments more targeted. Researchers say separating pain types could help improve prosthetic adjustments, gait-focused physical therapy, phantom pain treatment strategies, and rehabilitation for secondary musculoskeletal strain.
As the number of Americans living with limb loss continues to grow, the study underscores something many amputees have long understood firsthand: Pain is rarely one-dimensional, and better outcomes may depend on treating it that way.
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 the February issue of PM&R.
