Abstract

This paper is a mini-review on neuropathic pain after limb amputation, with a focus on diabetic patients. Diabetes mellitus is a major cause of lower-limb amputation, and neuropathic pain is among the most disabling sequelae. Peripheral neuropathy affects up to half of diabetic individuals, and 10–34% experience phantom limb pain and up to 59% report residual stump pain after amputation. The pathophysiology involves peripheral nerve injury, diabetes-induced metabolic and vascular toxicity, central sensitization, and glial activation, leading to persistent abnormal pain signaling. Neuropathic pain usually presents as painful diabetic peripheral neuropathy or phantom limb pain. Diagnosis relies on history and neurological examination, aided by tools such as DN4 or LANSS, though their accuracy remains limited. Management is mainly pharmacological, with gabapentinoids, serotoninnorepinephrine reuptake inhibitors, and tricyclic antidepressants as first-line agents, while multimodal and rehabilitative approaches may provide additional benefit. Heterogeneity of patients and lack of longitudinal data hinder standardization, highlighting the need for biomarkers and novel neuromodulatory strategies.

Keywords

diabetes, amputation, neuropathic pain