Post-Amputation Pain

Post-Amputation Pain Management Specialist in Tampa, FL

Treatment of Post-Amputation/Phantom Pain

Until recently, phantom limb pain and stump pain have been difficult to control. All this changed once the FDA approved percutaneous (under the skin) Peripheral Nerve Stimulators (PNS).

What is Peripheral Nerve Stimulation?

Peripheral nerve stimulation, frequently referred to as PNS, is a commonly used approach to treat sub-acute and chronic pain. It involves placement of a small electrical device (a wire-like electrode) next to one of the peripheral (not in the brain or spinal cord) nerves. The electrode delivers rapid electrical pulses that feel like mild tingles during the testing period. The electrode is connected to an external device, and if the trial is successful, the wire-like electrode is implanted under the skin near the nerve. Once implanted, a generator is worn over the skin to generate electricity, and the patient is able to control stimulation by turning the device on and off and adjusting stimulation parameters as needed.

Why choose TampaPainMD?

Dr. Kalava is one of the very few physicians in Florida who specialize in placement and management of PNS. We pride ourselves in using ultrasound guidance and thus eliminating any exposure to harmful radiation (x-ray). These procedures are done in the office and sometimes need mild sedation to perform. PNS can successfully achieve greater than 50% reduction in pain in the majority of patients, improving functionality and leading to better quality of life.

What are the main nerves that sense pain?

Upper Limb: A nerve can either individually or collectively be responsible for pain.

  • Radial Nerve
  • Ulnar Nerve
  • Median Nerve

Lower Limb: A nerve can either individually or collectively be responsible for pain.

  • Femoral Nerve
  • Sciatic Nerve

What is the insurance coverage?

Medicare fully covers peripheral nerve stimulation. Commercial insurances at this time do not cover PNS implantation.

Steps in Diagnosing & Managing your Phantom/Stump Pain:

  • Clinical Examination
  • Diagnostic Nerve Block (Ultrasound-Guided): To identify which nerve is causing pain or responsible for symptoms and also to ascertain whether your pain is mediated by the central nervous system (brain and spinal cord) or the peripheral nervous system (beyond the brain and spinal cord.)
  • Peripheral Nerve Stimulation

What are other therapeutic options?


  • Mayo Clinic Information on Residual Limb Pain (Read Here)
  • Radio Frequency Ablation for Phantom Pain (Read More)
  • Clinical Evidence on Military Veterans & Peripheral Nerve Stimulation Outcome (Read Here)
  • Clinical Evidence in Civilians and its Efficacy (Read Here)

Contact Us  Accepted Insurances  Professional Fees

Frequently Asked Questions

Ketamine is an anesthetic medication. It is a schedule 3 dissociative anesthetic, which has shown promising antidepressant effects that are both rapid and robust. It has been safely used for years as the ideal anesthetic in hospital and medical settings. When used under medical supervision, studies have shown ketamine infusions to have significant effects in healing treatment-resistant depression. It is on the World Health Organization’s List of Essential Medicines because of its safety and efficacy for anesthesia.

More recently, ketamine has been discovered as a safe and effective treatment for depression, and randomized controlled trials have shown rapid improvement in mood as well as reduction in suicidality compared to people who receive a placebo or another drug. Ketamine has the ability to go to work right away, unlike most antidepressants, which take weeks, sometimes months, to provide relief.

Ketamine infusion therapy is an IV procedure performed in-office by Dr. Kalava. Dr. Kalava & his associates will monitor your response and level of consciousness throughout the infusion.

Please contact our office to discuss Ketamine Infusion Therapy, and see if it is right for you.

The most important factors when choosing a ketamine provider are the doctor’s experience and commitment to providing safe, compassionate care. Dr. Kalava is the nation’s leading practitioner of ketamine infusion therapy and is a recognized expert in the field of anesthesiology.

[Scientific articles on Ketamine published by Dr. Kalava: Article 1 & Article 2 ]

Every patient is unique and deserves special care. Whether determining dose, infusion duration, the number of initial infusions, or the interval between return visits, we make individual assessments and structure ketamine treatments to match each patient’s response and unique needs.

Low dose ketamine is administered by Dr. Kalava, who is a Double Board Certified, Mayo Clinic fellowship trained Anesthesiologist. Ketamine, as we know, is an anesthetic and is best administered under the constant vigilance of a qualified anesthesiologist.

Depending on the medical condition being treated, IV ketamine can be administered over 1 minute, 40 minutes, one hour, or 4 hours. The actual type of treatment will be discussed with you during your initial consultation. The number of infusions and duration of ketamine therapy varies and is individualized. An average of 6-8 treatments are required for a good clinical response.

There are a handful of studies since 2014 that show promising results in managing symptoms from PTSD after ketamine infusion. (Study 1) (Study 2)(Study 3).

Mild psychotomimetic (confusion, hallucinations) effects, increase in heart rate, blood pressure, mild headache, and nausea are possible in some patients and are usually well tolerated.