Issue 24-5, 2025

Review

https://doi.org/10.38025/2078-1962-2025-24-5-113-130

Current Approaches to the Therapy and Rehabilitation of Patients with Postamputation Pain: a Review

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ORCID Sergei A. Rachin 1,2*, ORCID Karina A. Lytkina 3, ORCID Georgiy G. Melkonyan 2,3, ORCID Olga Yu. Karpova 4, ORCID Svetlana V. Topolyanskaya 3,4, ORCID Ekaterina A. Drozdova 4

1 National Association of Experts in Comorbid Neurology, Moscow, Russia
2 Russian Medical Academy of Continuous Professional Education, Moscow, Russia
3 Hospital for War Veterans No. 3 of the Moscow Health Department, Moscow, Russia
4 I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia


ABSTRACT

INTRODUCTION.  Postamputation pain is a complex, multifactorial condition that significantly reduces the quality of life in patients after limb amputation. According to our data, among 539 patients who underwent amputation at various levels, postamputation pain occurred in 55.3 %, most frequently after below-knee (64.5 %) and above-knee amputations (62.7 %), and less commonly after amputations of the forearm (31.0 %), upper arm (41.7 %), foot (25.8 %) and hand (26.3 %). Despite considerable progress in elucidating its pathophysiology, effective management of postamputation pain remains a major clinical challenge. The issue has gained further relevance due to the growing number of patients with combat-related injuries, particularly high-energy mine-blast injury, underscoring the need for optimal treatment and rehabilitation strategies.

AIM.  To summarize current data on therapeutic and rehabilitation approaches to postamputation pain within a multimodal strategy, taking into account the pathophysiological type of pain.

THE MAIN CONTENT OF THE REVIEW.  This review analyzes current strategies for managing postamputation pain within a multimodal framework. Particular attention is given to pharmacotherapy tailored to the pathophysiological type of pain — nociceptive, neuropathic, nociplastic, or mixed. Non-pharmacological approaches are also discussed, including neurorehabilitation techniques, neuromodulation interventions, and reconstructive surgical procedures. The necessity of a personalized therapeutic plan, with continuous monitoring of pain dynamics and quality-of-life indicators, is emphasized.

CONCLUSION.  Postamputation pain has a multifactorial and incompletely understood pathogenesis, which supports the potential effectiveness of both conservative and surgical treatment approaches. However, standardized protocols and convincing evidence favoring specific interventions are lacking. Further investigation into the mechanisms underlying this condition will help define optimal therapeutic and rehabilitation strategies for affected patients.

KEYWORDS: postamputation pain, phantom limb pain, residual limb pain, high-energy injuries, mine-blast injuries

FOR CITATION:

Rachin S.A., Lytkina K.A., Melkonyan G.G., Karpova O.Yu., Topolyanskaya S.V., Drozdova E.A. Current Approaches to the Therapy and Rehabilitation of Patients with Postamputation Pain: a Review. Bulletin of Rehabilitation Medicine. 2025; 24(5): 113-130. https://doi.org/10.38025/2078-1962-2025-24-5-113-130 (In Russ.). 

FOR CORRESPONDENCE:

Sergei A. Rachin, Е-mail: rachin.sergei@com-neurology.ru


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This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.