A medical student asked me a very interesting question today-- one that I very rarely get asked:  "Does your socket ever hurt?"  For anyone who doesn't know what a socket is, it's the part of the prosthesis that your 'natural' anatomy fits into.  For me, it's the thigh portion of my right lower extremity.  My first reaction to this question is, of course 'no, my socket doesn't hurt'... and if anyone's socket hurts they need to call up the prosthetist pronto for an adjustment.  A socket that hurts can be a huge red flag.  Many times an uncomfortable socket is a result of anatomical change or a poorly designed prosthesis.  The advocate and care coordinator in me thinks more along those lines.  It shouldn't hurt... that means something is wrong and a prosthetist needs to fix it.  I wear my prosthesis at least 16 hours a day, every day.  I take care of my kids, work, do pretty much anything I need to.  But is my prosthesis always perfectly comfortable?  Honestly, not really.  Not really, when I've been walking up and down the aisles of a grocery store for two hours after a long day of work.  Not really when it's a hot summer day and I'm running around like a crazy person.  There, I've said it.  When I really think about it, it's kind of an injustice to deny that there is some discomfort involved.  It reminds me of when I had my first child and I started nursing her.  My thought was, "What the heck is wrong?!  This hurts like the dickens!!!!"  And then suddenly women confided to me that, yes, this is the case.  A prosthetic socket is plastic where there should be no plastic... sensitive skin doing a lot of hard work.  I think about how I feel when I take it off right before bed and think... 'Ahhhh'.  And that's coming from me-- someone who is 200% happy with my prosthesis and think this is the most incredible socket anyone could ever make for me.  I don't develop any sores, no redness, no blisters.  But still, it's a 'prosthesis'.  It's not a real leg.  And so there are going to be some 'aches and pains' occasionally.  So how can you tell the difference?  Is this a 'real' problem that needs to be fixed, or is this a level of discomfort that is tolerable, not constant, and non-threatening?  It's a good question and I'm not sure I have all the answers... that's where a prosthetist comes in.  Having said that, some good questions to consider are:
 

• Has there been a lack of follow up with the prosthetist?  If so, schedule an appointment ASAP. 
• Is there any sign of pressure or breakdown on the residual limb (redness, sores, blisters, etc...)?  If so, call the prosthetist. 
• Was there an event that triggered the pain?  Pain related to an injury needs to be addressed immediately.     
• Is the pain preventing daily activities?  Big problem. 
• Is the pain constant?  Not good. 
• Has the residual limb changed in size and/or volume recently?  Maybe the fit is the problem. 
• Is there a history of anatomical issues, such as vascular problems, neuromas, or heterotopic ossification?  The doctor definitely needs to be involved. 
• Has the prosthetic alignment been recently changed?  That can sometimes change the way a socket feels.  Even using shoes with the wrong heel height can cause socket problems. 
• What kind of 'pain' is this?  (throbbing, sharp, dull, stinging, etc...)

Pain is so relative... sometimes it's hard to talk about it.  The term 'pain' can include everything from minor aches to more severe, acute sensations.  We all have different pain tolerances. How do you perceive the pain?  Is there emotional pain tied to the physical pain?  I think anyone that has used a prosthetic limb for more than a year can say that the initial discomfort during use lessens over time.  The body does get more accustomed to it.  Sometimes aches & pains come & go.  There are good days and not-so-good days.  Understanding your pain & knowing when it's a warning sign can be difficult to do, particularly for those who are new to the world of prosthetics.  It's important not to down-play pain, but I understand that occasional discomfort is to be expected from time to time.  If it's stopping you from doing what you want to do... then, Houston, we have a problem.