Researchers at the University of Colorado Anschutz have identified a critical gap in how post-amputation pain is evaluated and treated. The study shows 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. These findings could influence care strategies for the nearly two million Americans living with limb loss, a number expected to grow in the coming decades.
The research, recently published in PM&R, examined 83 adults living with unilateral transfemoral or transtibial amputation. Participants 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 and co-director of amputation medicine and rehabilitation for the Osseointegration and Limb Restoration Program at the University of Colorado Anschutz.
The study showed most participants experienced more than one type of pain. They include:
Each pain behaved differently during activity, showing why combining all pain into a single overall score can mask important patterns.
“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 (BAL) 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 limbs, 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 highlights that some socket prosthesis users experience pain that spikes with movement, while those with bone anchored limbs often report stable pain levels regardless of activity. These differences underscore how prosthetic design can directly influence comfort during real-world movement, with implications for mobility, daily function and quality of life.
The study suggests clinicians should assess each type of pain separately. A more detailed assessment may help guide:
“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.”
For more information please visit the CU Anschutz Department of Physical Medicine and Rehabilitation and the CU Anschutz Limb Restoration Program.