Low prevalence of painful neuroma and phantom limb pain in lower extremity amputations of leprosy patients

Background Painful neuroma and phantom-limb pain (PLP) are common, debilitating complications after lower-extremity amputation, yet their frequency in people with leprosy is largely unknown. Leprosy is associated with prolonged deafferentation, which may alter peripheral and central pain processing mechanisms, potentially reducing the risk of post-amputation pain. This study evaluated the expert-reported prevalence of painful neuroma and PLP in patients with leprosy who underwent below-knee amputations (BKA). Methods We conducted a cross-sectional, web-based survey between 06/2024 and 04/2025 involving 14 global leprosy specialists, each with over 10 years of clinical experience managing leprosy-related amputations. The structured questionnaire, distributed via REDCap, captured the estimated prevalence of painful neuroma and PLP in leprosy patients with BKAs, as well as comparative data from non-leprosy amputees managed by the same clinicians. Results All 14 respondents provided data on painful neuromas, and 11 provided data on PLP. Painful neuromas in leprosy amputees were reported at significantly lower rates than in non-leprosy amputees (p = 0.002), with most clinicians indicating frequencies in the 0–16% range. PLP was also skewed toward low prevalence, but the difference compared to non-leprosy patients was not statistically significant (p = 0.25). Conclusion Expert opinion suggests that leprosy-related BK amputees experience markedly fewer painful neuromas and modestly less PLP than amputees without leprosy. These findings suggest unique neuropathic adaptations in leprosy patients, possibly due to chronic deafferentation.