Like any type of surgery, having an amputation carries a risk of complications. The treatment also carries a risk of additional problems directly related to the loss of a limb.

There are a number of factors that influence the risk of complications from amputation, such as your age, the type of amputation you had, and your general health.

The risk of serious complications is lower in planned amputations than in emergency amputations.

Complications associated with having an amputation include:

• heart complications – such as heart attack
• blood clots (venous thrombosis)
• slow wound healing and wound infection
• pneumonia (infection of the lungs)
• stump and "phantom limb" pain
• psychological problems

In some cases, further surgery may be required to correct problems that develop.

An amputation is often seen a last resort when other treatments have failed. However, for many people, the loss of pain and a properly healed limb results in a significant improvement in their quality of life. If the person is supported appropriately, they can return to a near normal life. 

Stump and 'phantom limb' pain

Many people who have an amputation will experience some degree of stump pain or "phantom limb" pain.

Phantom limb sensations are when a person experiences sensations that seem to be coming from the limb that has been amputated. Sometimes this is just awareness of the limb, but it can occasionally be painful. This is known as phantom limb pain.

The term "phantom" does not mean that the symptoms of pain are imaginary and all in your head. Phantom limb pain is a very real phenomenon, which has been confirmed using brain imaging scans to study how nerve signals are transmitted to the brain.

The symptoms of phantom limb pain can range from mild to severe. Some people have described brief "flashes" of mild pain, similar to an electric shock, that last for a few seconds. Other people have described constant severe pain.

The causes of phantom limb pain are unclear. There are three main theories:

• The peripheral theory argues that phantom limb pain may be the result of nerve endings around the stump forming into little clusters known as neuromas. These may generate abnormal electrical impulses that the brain interprets as pain.
• The spinal theory suggests that the lack of sensory input from the amputated limb causes chemical changes in the central nervous system. This leads to "confusion" in certain regions of the brain, triggering symptoms of pain. 
• The central theory proposes that the brain has a "memory" of the amputated limb and its associated nerve signals. Therefore, the symptoms of pain are due to the brain trying to recreate this memory, but failing because it is not receiving the feedback it was expecting. 

Stump pain can have many different causes, including rubbing or sores where the stump touches a prosthetic limb, nerve damage during surgery and the development of neuromas.

Treating stump and phantom limb pain

Both stump and phantom limb pain will usually improve over time, although there are many treatments available to help relieve your symptoms.

However, it can be difficult to treat the pain, as the effectiveness of each treatment varies between different people. Several types of treatment may need to be tried.

Medications

Medications that may be tried by your doctor to help relieve pain include:

• non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen
• anticonvulsants – such as carbamazepine or gabapentin
• antidepressants – such as amitriptyline or nortriptyline
• opioids – such as codeine or morphine
• corticosteroid or local anaesthetic injections

Non-invasive therapy

There are several non-invasive techniques that may help relieve pain in some people. They include: 

• checking the fit of your prosthesis and making any adjustments to make it feel more comfortable
• applying heat or cold to your limb, such as using heat or ice packs, rubs and creams
• massage – to increase circulation and stimulate muscles
• acupuncture – where needles are inserted into the skin at specific points on the body thought to stimulate the nervous system and relieve pain
• transcutaneous electrical nerve stimulation (TENS) – a small, battery-operated device that has leads connected to electrodes is used to either deliver electrical impulses to the affected area of your body, or block or reduce the pain signals going to the spinal cord and brain
• mental imagery (see below)

Mental imagery

Research carried out in Liverpool in 2008 found that if people spent 40 minutes imagining using their phantom limb, such as stretching out their "fingers" or bunching up their "toes", they experienced a reduction in pain symptoms.

This may be related to the central theory of phantom limb pain (that the brain is looking to receive feedback from the amputated limb), and these mental exercises may provide an effective substitution for this missing feedback.

One technique that can also be used is known as mirror visual feedback. This is where a mirror is used to create a reflection of the other limb. Some people find that by doing exercises and moving their other limb, it can help to relieve pain from a phantom limb.

Surgery

In some cases, further surgery may be considered to relieve your pain. For example, if neuromas are thought to be causing pain, the cluster of nerves may need to be removed.

Psychological impact of amputation

The loss of a limb can have a considerable psychological impact. Many people who have had an amputation report feeling emotions such as grief and bereavement, similar to experiencing the death of a loved one.

Coming to terms with the psychological impact of an amputation is therefore often as important as coping with the physical demands.

Having an amputation can have a considerable psychological impact for three main reasons:

• you have to cope with the loss of sensation from your amputated limb
• you have to cope with the loss of function from your amputated limb
• your sense of body image, and other people’s perception of your body image, has changed

It's common to experience negative thoughts and emotions after an amputation. This is especially true in people who had an emergency amputation, as they did not have time to mentally prepare themselves for the effects of surgery.

Common negative emotions and thoughts experienced by people after an amputation include:

• depression
• anxiety
• denial (refusing to accept that they need to make changes, such as having physiotherapy, to adapt to life with an amputation)
• grief
• feeling suicidal

People who have had an amputation due to trauma (especially members of the armed forces injured while serving in Iraq or Afghanistan) also have an increased risk of developing post-traumatic stress disorder (PTSD). This is when a person experiences a number of unpleasant symptoms after a traumatic event, such as "reliving" the event and feeling constantly anxious.

Talk to your care team about your thoughts and feelings, especially if you are feeling depressed or suicidal. You may require additional treatment, such as antidepressants or counselling, to improve your ability to cope with living with an amputation.