Original article
Phantom Pain, Residual Limb Pain, and Back Pain in Amputees: Results of a National Survey

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Abstract

Ephraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin LE. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey.

Objectives

To describe the prevalence of amputation-related pain; to ascertain the intensity and affective quality of phantom pain, residual limb pain, back pain, and nonamputated limb pain; and to identify the role that demographics, amputation-related factors, and depressed mood may contribute to the experience of pain in the amputee.

Design

Cross-sectional survey.

Setting

A sample of persons who contacted the Amputee Coalition of America from 1998 to 2000 were interviewed by telephone.

Participants

A stratified sample by etiology of 914 persons with limb loss.

Interventions

Not applicable.

Main Outcome Measures

Prevalence, intensity, and bothersomeness of residual, phantom, and back pain, depressed mood as measured by the Center for Epidemiologic Study Depression Scale, characteristics of the amputation, prosthetic use, and sociodemographic characteristics of the amputee.

Results

Nearly all (95%) amputees surveyed reported experiencing 1 or more types of amputation-related pain in the previous 4 weeks. Phantom pain was reported most often (79.9%), with 67.7% reporting residual limb pain and 62.3% back pain. A large proportion of persons with phantom pain and stump pain reported experiencing severe pain (rating 7–10). Across all pain types, a quarter of those with pain reported their pain to be extremely bothersome. Identifiable risk factors for intensity and bothersomeness of amputation-related pain varied greatly by pain site. However, across all pain types, depressive symptoms were found to be a significant predictor of level of pain intensity and bothersomeness.

Conclusions

Chronic pain is highly prevalent among persons with limb loss, regardless of time since amputation. A common predictor of an increased level of intensity and bothersomeness among all pain sites was the presence of depressive symptoms. Further studies are needed to elucidate the relationship between pain and depressive symptoms among amputees.

Section snippets

Study Design and Sample

The study was a cross-sectional survey design that was conducted as part of a larger project, the Limb Loss Research and Statistics Program (LLRSP). The LLRSP is a partnership between the Johns Hopkins University Bloomberg School of Public Health and the Amputee Coalition of America (ACA). Using an existing database, we identified 6500 amputees who had contacted the ACA between 1998 and 2000. Of these, we selected a sample of 1538 amputees stratified by etiology (608 persons with amputation

Measures

The survey consisted of 5 parts: (1) demographics and characteristics of the amputation; (2) general health and well-being; (3) measures of pain and depressed mood; (4) use and satisfaction with prosthesis; and (5) use and unmet needs for medical services. Our primary outcome measures for this analysis were phantom pain, residual limb pain, back pain, and nonamputated limb pain.

Characteristics of the Study Population

Of the 1538 persons identified for the survey, 182 were ineligible due to age (n=5; 2.2%), type or level of amputation (n=12; 6.6%), lack of an amputation (n=29; 15.9%), non-English speaking (n=6; 3.3%), physically or mentally unable to respond (n=19; 10.4%), or death or institutionalization (n=111; 61.0%). Of those eligible for participation, 960 (71.3%) completed the interview, of which 21 were conducted with a proxy respondent who resided in the home. One hundred forty-seven persons could

Discussion

Overall, 95% of amputees reported having 1 or more types of amputation-related pain during the preceding 4 weeks. The most common type of amputation-related pain cited was phantom limb pain (79.9%). Similar to previous reports, no statistically significant differences were found in the prevalence of phantom pain by etiology, age or level of amputation after controlling for other potential confounding factors.4, 6, 10 In a sample comprised of traumatic and dysvascular amputees, Houghton et al12

Conclusions

This is the first national survey to report the intensity of and risk factors for phantom pain, residual limb pain, and nonamputated limb pain in community-dwelling persons with limb loss. Chronic pain is highly prevalent among persons with limb loss regardless of time since amputation. While there are several identifiable risk factors for intensity and bothersomeness of amputation-related pain, these varied greatly by pain site. The size of our sample allows for control of multiple factors to

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    Supported by the National Center for Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC; grant no. U59/CCU416733). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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