 All Subjects scheduled for surgery will then undergo amputation under the anesthetic technique of provider choice. If regionalneuraxial anesthetic techniques are used they will be standardized up to 1 day preoperative and 3 days postoperative. If using dexmedetomidine andor ketamine infusions, their use will be limit to intraoperative periods at doses of 0.2 mcgkghr and 0.15mgkghr limit respectively. AnesthesiologistAnesthetist choice will be permitted for all other intraoperative and postoperative meds. Within 1 week of amputation subjects will again repeat 14 days of their respectively assigned therapy limbs as described above in addition to routine post amputation care. All subjects will then be evaluated at four weeks postoperatively with measures delineated in section 5.Statistics to determine 1 incidence and severity of phantom limb pain 2 participation in therapy and ability to meet functional endpoints 3 quality of life. These same measures will be assessed at 12 weeks 3 months and again at one year post procedure. A repeat fMRI will be obtained in those Subjects participating in the fMRI limb in order to evaluate how the postoperative cortical mapping compares to prior preoperative and postoperative studies. 