Post-Amputation Nerve Pain After Five Surgeries: Rodney’s Story
Before he found Dr. Tim Tollestrup, Rodney had undergone five surgeries for post-amputation nerve pain, and none of them worked. After his below-knee amputation, he developed severe nerve pain that made it difficult to wear his prosthesis. Each surgery was supposed to help. Instead, Rodney felt worse than when he started. “There’s a lot of amputees in this country that I think are self-medicating and just in misery because they’re told it’s in their head,” says Rodney/
Why Nerve Pain Develops After Amputation
Every amputation cuts through nerves. That includes the large nerves most people think of and smaller cutaneous nerves that carry sensation from the skin. When cut nerves aren’t managed correctly, they can form painful neuromas and keep sending pain signals long after the surgery has healed. The result is residual limb pain: burning, stabbing or skin-level pain that can make wearing a prosthesis unbearable.
The anatomy of these smaller nerves can vary a great deal from one person to another. That variation is one reason post-amputation nerve pain is so often misdiagnosed or undertreated.
Five Surgeries, No Relief
Rodney’s first procedure was targeted muscle reinnervation (TMR), a technique that reroutes cut nerves into nearby muscle. It didn’t help. A second TMR revision didn’t either. Three more surgeries followed, each one trying to chase down a different nerve that might be causing the pain.
Dr. Tollestrup notes that Rodney’s previous surgeon was accomplished and experienced in peripheral nerve surgery. But reconstructive nerve surgery and pain-focused nerve surgery are very different disciplines. “He’s a reconstructive peripheral nerve surgeon, and those two disciplines are really totally different,” Dr. Tollestrup explains.
Wanting a new set of eyes, Rodney searched online and found Dr. Tollestrup.
Finding the Source of the Pain
When Rodney came to Las Vegas, Dr. Tollestrup mapped exactly where his pain was:
- down the back of his thigh and into his calf
- along the inner thigh
- into the front of his below-knee amputation stump
Each area pointed to specific nerves. The pain on the back of the thigh matched the posterior femoral cutaneous nerve. The pain on the inner thigh and knee matched the saphenous nerve and the sensory branch of the obturator nerve.
To confirm, Rodney underwent diagnostic nerve blocks. These injections temporarily turn off specific nerves to show whether they’re responsible for the pain. The blocks gave him very good relief, especially from his skin-level pain.
One Surgery That Made the Difference
Based on those results, Dr. Tollestrup took Rodney to the operating room and disconnected three sources of pain:
- the posterior femoral cutaneous nerve plexus
- the saphenous nerve
- the sensory branches of the obturator nerve
Rodney experienced very good resolution of the skin pain down the back of his thigh and calf, as well as most of the pain along his inner thigh and knee.
“When I woke up, I could tell he did more in that one surgery than all of the other ones combined,” Rodney says. “All the other surgeries were nipping around the edges. He pulled the whole thing out.”
Next Steps for Rodney
Some of Rodney’s deeper pain appears to come from the sciatic nerve that was treated in his earlier TMR procedures. Some also appears to come from branches of the anterior femoral cutaneous nerve. He has since undergone additional diagnostic blocks to guide the next phase of treatment, using the same step-by-step approach.
If You’re an Amputee Still Living With Pain
Post-amputation nerve pain is not in your head, and you don’t have to accept it as permanent. “If you’ve had an amputation and you’re still dealing with a lot of nerve pain, there’s definitely things that could potentially be done to reduce that or even eliminate it,” Dr. Tollestrup says.
Dr. Tollestrup is one of only four surgeons in the U.S. performing pain-focused peripheral nerve surgery, and patients travel to Las Vegas from across the country to see him.
Book an appointment: Call (702) 666-0463 or visit nevadanervesurgery.org
Individual results vary. This story reflects one patient’s experience and is not medical advice.