Residual limb pain is not a diagnosis: a proposed algorithm to classify postamputation pain.

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BACKGROUND: Although postamputation pain (PAP) syndromes have been described since the 16th century, taxonomy of these conditions remains ill-defined. The term "Residual Limb Pain" fails to distinguish between distinct diagnostic entities such as neuroma, complex regional pain syndrome, and somatic pathology. Even phantom limb pain (PLP), although easily distinguished from residual limb pain (RLP), has not been consistently delineated from other PAP syndromes. METHODS: A systematic review of the literature was conducted to identify the degree of delineation of various post amputation pain states and what diagnostic criteria were utilized if any. Furthermore, papers that involved treatment modalities were reviewed to determine efficacy of treatment. RESULTS: Of the 151 papers reviewed, none further categorized RLP into more specific diagnostic criteria. Furthermore, the literature contains numerous case reports, case series, letters to the editors, and grossly underpowered studies demonstrating significant positive results, yet few high-quality randomized controlled trials. CONCLUSIONS: Describing and defining the distinct clinical entities, intuitively, is a prerequisite to developing optimal treatments. The reported variation in the incidence of PAP phenomena may well represent inconsistency in assessment tools and diagnostic categories rather than variation in prevalence of these conditions. In this paper, we review the historical evolution of the current understanding of these syndromes and propose an algorithm for uniform classification.





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Clarke, Collin, David R Lindsay, Srinivas Pyati and Thomas Buchheit (2013). Residual limb pain is not a diagnosis: a proposed algorithm to classify postamputation pain. The Clinical journal of pain, 29(6). pp. 551–562. 10.1097/ajp.0b013e318261c9f9 Retrieved from

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David Richard Lindsay

Assistant Consulting Professor in the Department of Anesthesiology

Srinivas Pyati

Associate Professor of Anesthesiology

Thomas Edward Buchheit

Associate Professor of Anesthesiology

Dr. Buchheit serves as Director of the Regenerative Pain Therapies Program in the Duke Center for Translational Pain Medicine (CTPM), and practices Pain Medicine at both Duke University and the Durham VAMC. His research focus is on the local and systemic inflammatory mechanisms that drive pain in arthritis and nerve injury. He has led and participated in several multicenter research projects that have studied patients at Duke, the Durham VAMC, and Walter Reed National Military Medical Center, clarifying post-amputation pain phenotypes and mechanisms that drive the chronification of pain. These research pursuits have guided the clinical and translational programs of CTPM that strive develop biologically-based methods for the treatment of arthritis and degenerative musculoskeletal conditions. The program’s overarching goal is to move beyond opioids, steroids and anti-inflammatory medications for the treatment of pain. 

Dr. Buchheit currently serves on the Editorial Board of Pain Medicine and recently completed service as Pain Medicine Division Chief in the Duke Department of Anesthesiology. He also serves on the Board of The Pain Society of the Carolinas and previously on the American Society of Anesthesiologists Pain Medicine Committee, (2012-2014), as an American Board of Anesthesiology Question Author (2011-2014), and President of Pain Society of the Carolinas (2015-2017).  

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