Phantom Limb Sensation Research Articles

Robotic-Enhanced Prosthetic Liners for Vibration Therapy: Reducing Phantom Limb Pain in Transfemoral Amputees.

Phantom limb pain, a common challenge for amputees, lacks effective treatment options. Vibration therapy is a promising non-pharmacologic intervention for reducing pain intensity, but its efficacy in alleviating phantom limb pain requires further investigation. This study focused on developing prosthesis liners with integrated vibration motors to administer vibration therapy for phantom limb pain. The prototypes developed for this study addressed previous issues with wiring the electronic components. Two transfemoral amputees participated in a four-week at-home trial, during which they used the vibration liner and rated their initial and final pain intensity on a numeric rating scale each time they had phantom pain. Semi-structured interviews were conducted to gather feedback following the at-home trial. Both participants described relaxing and soothing sensations in their residual limb and phantom limb while using vibration therapy. One participant reported a relaxation of his phantom limb sensations, while both participants noted a decrease in the intensity of their phantom limb pain. Participants said the vibration liners were comfortable but suggested that the vibration could be stronger and that aligning the contacts could be easier. The results of this study highlight the potential effectiveness of using vibration therapy to reduce the intensity of phantom limb pain and suggest a vibration liner may be a feasible mode of administering the therapy. Future research should address optimizing the performance of the vibration liners to maximize their therapeutic benefits.

Development and pilot administration of the amputation-related pain and sensation assessment tool

Purpose To develop and administer an assessment tool for facilitating patient–clinician discussions regarding amputation-related pain and sensation. Materials and methods An assessment tool was developed to measure the impact of different types of amputation-related pain and sensation on a patient’s life. The tool first provides patients with written descriptions and images of three common types of amputation-related pain or sensations: residual limb pain, phantom limb sensation, and phantom limb pain. The tool then asks them to rate the frequency, intensity, and interference of each experience. Participants were also asked to provide qualitative descriptions of these experiences. Results Fifty Veterans with lower limb amputation participated in the study. In the past month, 74% reported experiencing residual limb pain, 76% reported phantom limb sensation, and 84% reported phantom limb pain, with 52% reporting all three. Participants’ descriptions of some experiences were distinct, while others (e.g., “tingling”) were common between experiences. Phantom limb pain had the most varied descriptions. Conclusions The amputation-related pain and sensation assessment tool can be used to identify and measure the effects of different experiences on patients’ lives, thereby improving the specificity of diagnosis and informing clinical treatment recommendations. Further development of this tool should include evaluating its psychometric properties.

Effect of transcranial direct current stimulation on supernumerary phantom limb pain in spinal cord injured patient: A case report

BACKGROUND Supernumerary phantom limb (SPL) sensation is the experience of additional limbs, either single or a pair of limbs. Unique to traumatic spinal cord injuries, we report effect of transcranial direct current stimulation (tDCS) on SPL pain in a patient with cervical cord injury. CASE SUMMARY The subject was a 57-year-old man who was diagnosed with complete spinal cord injury (C6/C5, motor level; C5/C5, sensory level; AIS-A) approximately three months ago. After a period of 2 wk, we administered anodal tDCS over the motor cortex for 15 minutes at an intensity of 1.5 mA. Following that treatment, the patient experienced a decrease of SPL pain intensity and frequency, which lasted for 1 week after the end of treatment. CONCLUSION Targeting the motor cortex through neuromodulation appears to be a promising option for the management of SPL pain.

The prevalence and risk factors for phantom limb pain: a cross-sectional survey

BackgroundWe previously performed a systematic review and meta-analysis which revealed a Phantom Limb Pain (PLP) prevalence estimate of 64% [95% CI: 60.01–68.1]. The prevalence estimates varied significantly between developed and developing countries. Remarkably, there is limited evidence on the prevalence of PLP and associated risk factors in African populations.MethodsAdults who had undergone limb amputations between January 2018 and October 2022 were recruited from healthcare facilities in the Western and Eastern Cape Provinces. We excluded individuals with auditory or speech impairments that hindered clear communication via telephone. Data on the prevalence and risk factors for PLP were collected telephonically from consenting and eligible participants. The prevalence of PLP was expressed as a percentage with a 95% confidence interval. The associations between PLP and risk factors for PLP were tested using univariate and multivariable logistic regression analyses. The strength of association was calculated using the Odds Ratio where association was confirmed.ResultsThe overall PLP prevalence was 71.73% [95% CI: 65.45–77.46]. Persistent pre-operative pain, residual limb pain, and non-painful phantom limb sensations were identified as risk factors for PLP.ConclusionThis study revealed a high prevalence of PLP. The use of effective treatments targeting pre-amputation pain may yield more effective and targeted pre-amputation care, leading to improved quality of life after amputation.

A Case of Upper Limb Amputation Managed with USG-guided Continuous Infraclavicular Nerve Block for Improved Postoperative Analgesia

Phantom Limb Pain (PLP) is defined as any perceived painful sensation localised to the region of the amputated body part, while phantom limb sensations are non painful sensations emanating from the phantom limb, including proprioceptive awareness, kinetic, exteroceptive, and superadded sensations. The mode of anaesthesia administered during amputation is an important factor in determining the emergence of PLP or phantom sensations. The majority of patients requiring emergency care are victims of traumatic injuries to the upper limbs, which are most often treated conservatively. The authors present the case of a 67-yearold male patient who sustained a fall on his arm while carrying a metal container, resulting in a laceration to his left arm that led to disruption of brachial artery blood flow, necessitating amputation. Although upper limb injuries are relatively common, concurrent vascular injuries are rare. However, when a major vessel such as the brachial artery is injured, amputation may be required. This loss of a limb can result in PLP. To prevent this, the authors used a unique and rare protocol of Continuous Peripheral Nerve Block (CPNB) in the present case. It not only underscored the importance of intraoperative analgesia in preventing PLP but also proved to be a crucial anaesthetic tool in facilitating the surgery and providing the patient with a more comfortable postoperative recovery.

Experience to date with elective transfemoral amputations incorporating agonist-antagonist myoneural interface (AMI) design

IntroductionThe agonist-antagonist myoneural interface (AMI) is a surgical construct that, when incorporated into limb amputation, offers to potential to preserve or restore proprioception, augment functionality, reduce neuropathic pain and enhance overall limb stability. We here present our experience to date with AMI construction in the context of transfemoral amputation (TFA). MethodsPatients were recruited for TFA with AMI construction at Brigham & Women’s and Brigham & Women’s Faulkner Hospital between June 2018 and June 2023. Data collection included demographic information, intraoperative parameters, clinical recovery metrics and complications. All data was then collated and analyzed. ResultsSeven TFA procedures were performed on seven patients during the study period. The operative technique employed evolved significantly over time, and included the development of both native and regenerative AMI models. Four patients were biological males (57%), and mean patient age was 42.0 ± 14.6 years. The etiology of conditions necessitating amputation included traumatic (43%), oncologic (29%), iatrogenic (14%) and congenital (14%). Mean operative time was 566 ± 97 min and average length of stay was 11.7 ± 8.4 days. Average postoperative follow-up was 2.19 ± 1.57 years (range 0.81–4.30 years). Postoperative imaging of AMI constructs demonstrated average muscle excursions of 6±3 mm, and total average limb volume preservation over time was 102 ± 14%. All patients demonstrated a complete wean from narcotic pain medications, with a mean time to wean of 86 ± 79 days. Minimal neuropathic pain was reported after the acute postoperative period. All seven (100%) of the subjects reported functional phantom limb sensation over the same time. Complications included significant soft tissue necrosis in two (29%) patients and minor wound healing issues in one (14%) patient. ConclusionsTFA incorporating AMI construction appears to offer promising benefits similar to those previously reported in patients undergoing similar interventions at the transtibial level.

Phantom Limb Pain: Current Concepts and Treatment Strategies

Phantom limb syndrome (PLS) is described as the perception of feelings originating from a limb that has been amputated or is otherwise absent [1]. Despite this physical absence, patients may experience various sensory and motor sensations as if the limb were still present. Phantom limb symptoms encompass a range of sensations, including the missing limb's presence, movements such as wiggling toes or opening and closing the hand, pressure, tingling, itching, temperature changes, and pain [1-3]. Phantom limb pain (PLP) is commonly encountered in these patients, and it can vary in intensity, duration, and quality, ranging from throbbing or stabbing sensations to burning or cramping feelings. There is a high statistical heterogeneity across prevalence studies due to the different time windows assessed [4-10]. However, it is estimated that approximately 60-80% of individuals who have undergone limb amputation may experience phantom limb sensations, and around 50-85% of those individuals may also experience phantom limb pain [11,12]. Several factors have been identified as potential risk factors for developing this type of pain, including the level of amputation, pre-existing pain, post-amputation pain, chronic pain history, and psychological factors (i.e., anxiety, depression, post-traumatic stress disorder) [12,13].

Effect of a continuous perineural levobupivacaine infusion on pain after major lower limb amputation: a randomised double-blind placebo-controlled trial

ObjectivesRandomised controlled trial of the effect of a perineural infusion of levobupivacaine on moderate/severe phantom limb pain 6 months after major lower limb amputation.SettingSingle-centre, UK university hospital.ParticipantsNinety patients undergoing above-knee...

Myoelectric prosthesis hand grasp control following targeted muscle reinnervation in individuals with transradial amputation.

Despite the growing availability of multifunctional prosthetic hands, users' control and overall functional abilities with these hands remain limited. The combination of pattern recognition control and targeted muscle reinnervation (TMR) surgery, an innovative technique where amputated nerves are transferred to reinnervate new muscle targets in the residual limb, has been used to improve prosthesis control of individuals with more proximal upper limb amputations (i.e., shoulder disarticulation and transhumeral amputation). The goal of this study was to determine if prosthesis hand grasp control improves following transradial TMR surgery. Eight participants were trained to use a multi-articulating hand prosthesis under myoelectric pattern recognition control. All participated in home usage trials pre- and post-TMR surgery. Upper limb outcome measures were collected following each home trial. Three outcome measures (Southampton Hand Assessment Procedure, Jebsen-Taylor Hand Function Test, and Box and Blocks Test) improved 9-12 months post-TMR surgery compared with pre-surgery measures. The Assessment of Capacity for Myoelectric Control and Activities Measure for Upper Limb Amputees outcome measures had no difference pre- and post-surgery. An offline electromyography analysis showed a decrease in grip classification error post-TMR surgery compared to pre-TMR surgery. Additionally, a majority of subjects noted qualitative improvements in their residual limb and phantom limb sensations post-TMR. The potential for TMR surgery to result in more repeatable muscle contractions, possibly due to the reduction in pain levels and/or changes to phantom limb sensations, may increase functional use of many of the clinically available dexterous prosthetic hands.

Frequency of phantom limb pain, limb sensation and stump pain among amputees

Objective: To quantify the frequency of phantom limb pain, limb sensation and stump pain among amputees aging 20–75 years. Methods: An observational cross-sectional study was done. A population of 75 amputees were selected using non-probability convenient sampling and after setting the inclusion and exclusion criteria. Standard questionnaires; Groningen Questionnaire Problems after Arm Amputation (GQPAA) and Groningen Questionnaire Problems after Leg Amputation (GQPLA), were filled by interviewing the patients. All the patients were approached in the hospitals. Data was collected from Pakistan Institute of Medical Sciences, Islamabad and Fauji Foundation Hospital, Rawalpindi. The duration of study was 6 months from June 2021 to December 2021. Results: After compiling all the results from the questionnaires, it was unveiled that among 75 amputees, mean age was 43.12±11.43 years. Out of these amputees, 53.3% were upper limb amputees and 46.7% were lower limb amputees. the frequency of phantom sensation was 62.7%, 57.3% reported phantom limb pain and 84% experienced stump pain. Conclusion: The study concluded that most prevalent among the population was stump pain, which was followed by phantom limb sensations and the least prevalent of these three was phantom limb pain among the population.

Sensory stimulation for upper limb amputations modulates adaptability of cortical large-scale systems and combination of somatosensory and visual inputs

Touch-like phantom limb sensations can be elicited through targeted transcutaneous electrical nerve stimulation (tTENS) in individuals with upper limb amputation. The corresponding impact of sensory stimulation on cortical activity remains an open question. Brain network research shows that sensorimotor cortical activity is supported by dynamic changes in functional connections between relevant brain regions. These groups of interconnected regions are functional modules whose architecture enables specialized function and related neural processing supporting individual task needs. Using electroencephalographic (EEG) signals to analyze modular functional connectivity, we investigated changes in the modular architecture of cortical large-scale systems when participants with upper limb amputations performed phantom hand movements before, during, and after they received tTENS. We discovered that tTENS substantially decreased the flexibility of the default mode network (DMN). Furthermore, we found increased interconnectivity (measured by a graph theoretic integration metric) between the DMN, the somatomotor network (SMN) and the visual network (VN) in the individual with extensive tTENS experience. While for individuals with less tTENS experience, we found increased integration between DMN and the attention network. Our results provide insights into how sensory stimulation promotes cortical processing of combined somatosensory and visual inputs and help develop future tools to evaluate sensory combination for individuals with amputations.

Prevalence of Phantom Phenomena in Congenital and Early-Life Amputees

Phantom limb pain (PLP) is a common consequence of the amputation of a limb. Persons with congenital limb absence (congenital amputees) or an acquired limb amputation at an early age seem to rarely experience PLP. However, the number of available studies and their sample sizes are low. In the present cross-sectional study, we assessed the presence of several phantom phenomena in a sample of 99 adult unilateral congenital amputees (con) of whom 34 had a limb correction later in life (limbc) and 153 adult participants with a unilateral amputation before the age of 6 years (subgroups: amputation between birth and 2 years (0-2y; n = 48), 3-4 years (3-4y; n = 46), and 5 to 6 years (5–6y; n = 59)). We found a higher prevalence and intensity of PLP in the 5-6y group compared to the other groups. Residual limb pain (RLP) intensity was higher in the 3 to 4 y and 5 to 6 y groups compared to the con group. Non-painful phantom limb sensation (PLS) intensity and telescoping intensity were higher in the 5 to 6 y group compared to the con and 0 to 2 y groups. Our results indicate that PLP prevalence as well as intensity is low when the limb loss happened before the age of 5 years. PerspectiveThe prevalence of phantom limb pain, residual limb pain, and non-painful phantom limb sensation in congenital amputees and participants with an amputation early in life is low. This might be due to the missing or reduced nociceptive input from the residual limb to the brain and higher development-associated adaptability of the somatosensory system.

Pathophysiological and Neuroplastic Changes in Postamputation and Neuropathic Pain: Review of the Literature.

Background:Despite advancements in surgical and rehabilitation strategies, extremity amputations are frequently associated with disability, phantom limb sensations, and chronic pain. Investigation into potential treatment modalities has focused on the pathophysiological changes in both the peripheral and central nervous systems to better understand the underlying mechanism in the development of chronic pain in persons with amputations.Methods:Presented in this article is a discussion outlining the physiological changes that occur in the peripheral and central nervous systems following amputation. In this review, the authors examine the molecular and neuroplastic changes occurring in the nervous system, as well as the state-of-the-art treatment to help reduce the development of postamputation pain.Results:This review summarizes the current literature regarding neurological changes following amputation. Development of both central sensitization and neuronal remodeling in the spinal cord and cerebral cortex allows for the development of neuropathic and phantom limb pain postamputation. Recently developed treatments targeting these pathophysiological changes have enabled a reduction in the severity of pain; however, complete resolution remains elusive.Conclusions:Changes in the peripheral and central nervous systems following amputation should not be viewed as separate pathologies, but rather two interdependent mechanisms that underlie the development of pathological pain. A better understanding of the physiological changes following amputation will allow for improvements in therapeutic treatments to minimize pathological pain caused by amputation.

Factors affecting long-term outcome in dorsal root entry zone lesioning for brachial plexus avulsion.

Dorsal root entry zone (DREZ) lesioning is a classical and effective treatment for brachial plexus avulsion (BPA). However, because of a limited number of cases reported in the literature, the factors affecting surgical outcomes are not known. Furthermore, whether this ablative procedure in the spinal level can change the status of phantom limb pain (PLP) and phantom limb sensation (PLS) is unknown. We retrospectively reviewed the patients with preganglionic BPA who underwent DREZ lesioning at a single center. Patients' baseline characteristics and long-term pain and complications were collected. Postoperative changes in PLP and PLS were recorded. Kaplan-Meier analysis was used to evaluate pain-free survival. Multivariate Cox regression analysis was performed to identify factors affecting pain outcomes. A total of 112 patients met the study inclusion criteria. With an average (range) follow-up of 47.4 (10-134) months, the long-term effectiveness and complication rate were 82.1% and 25.9%, respectively. Of 37 patients (33.0%) who developed PLS, 67.6% (25/37) experienced pain relief, whereas in 45.9% (17/37), PLS disappeared or changed after DREZ lesioning. Multivariate analysis showed that patients with shorter pain duration (≤5 years) and PLS had worse pain outcomes. This study revealed factors that predict the pain outcome of DREZ lesioning based on a large series of cases. The diverse postoperative changes in phantom limb indicate that the mechanisms underlying PLS and PLP at the spinal or supraspinal level may vary among patients with BPA. Future studies should investigate the contribution of maladaptive brain plasticity to the outcomes of patients undergoing DREZ lesioning.

Phantom Limb Pain on Post-Surgical Amputation Osteosarcoma Children Patient

Osteosarcoma is a musculoskeletal malignancy that often occurs in pediatric patients requiring multidisciplinary management. Management in the form of amputation surgery (limb-salvage surgery) with a combination of chemotherapy or radiotherapy. Post-amputation complications that are often experienced by patient is postsurgical pain. Persistent Postsurgical Pain (PPSP) in pediatric patients is influenced by risk factors such as age, gender, preoperative preparation (pain intensity, anxiety, pain efficacy), intraoperative measures (site of surgery, potential for nerve damage, administration of analgesia regimens, technique of anesthesia), and postoperative management. The incidence of PPSP in osteosarcoma postamputation patients is related to Phantom Limb Syndrome with varying incidence and duration. This syndrome is a phenomenon that often occurs after post-amputation procedures in the form of sensation (Phantom Limb Sensation) or pain (Phantom Limb Pain) due to loss of part of the body. Phantom Limb Pain (PLP) is an effect and complication that occurs after amputation surgery in pediatric osteosarcoma patients. The PLP pathomechanism is related to the interaction of the Central Nervous System (Cortical Remapping Theory and Proprioceptive Theory) and the Peripheral Nervous System (Dorsal Root Ganglia and nocireceptor stimulation). Management of PLP consists of neuropathic pain medications such as antidepressants, opioids, anticonvulsants, N-methyl-D-aspartate (NMDA) receptor antagonists and other anesthetic agents.

Transcranial direct current stimulation in the management of phantom limb pain: a systematic review of randomized controlled trials.

Phantom limb pain (PLP) after amputation is a frequent entity that conditions the life of those who suffer it. Current treatment methods are not sufficiently effective for PLP management. We aim to analyze the clinical application of transcranial direct current (tDCS) in people with amputation suffering from PLP. The following databases were consulted in September 2021: MEDLINE, EMBASE, The Web of Science, PEDro, SCOPUS and SciELO. Randomized controlled trials investigating the use of tDCS in people with amputation undergoing PLP were selected. Demographic data, type and cause of amputation, time since amputation, stimulation parameters, and outcomes were extracted. Six articles were included in this review (seven studies were considered because one study performed two individual protocols). All included studies evaluated PLP; six evaluated the phantom limb sensations (PLS) and two evaluated the psychiatric disorders. In all included studies the intensity and frequency of PLP was reduced, in three PLS were reduced, and in none study psychiatric symptoms were modified. Anodic tDCS over the contralateral M1 to the affected limb, with an intensity of 1-2 mA, for 15-20 minutes seems to significantly reduce PLP in people with amputation. Single-session treatment could modify PLP intensity for hours, and multi-session treatment could modify PLP for months. Limited evidence suggests that PLS and psychiatric disorders should be treated with different PLP electrode placements. Further studies with larger sample size and longer follow-up times are needed to establish the priority of tDCS application in the PLP management.

Association of Peripheral Serum MicroRNAs With Persistent Phantom Limb Pain in Individuals With Amputation.

Individuals with major limb amputation(s) frequently experience phantom limb sensations, which are described as vivid impressions of either parts or entire missing limb(s). Despite the high incidence and prevalence of phantom limb pain, the underlying pathophysiology of phantom limb pain remains poorly understood. The objective of this study was to evaluate a possible role of microRNAs in the pathophysiology of phantom limb pain. Adults with acquired limb amputation and varying degrees of phantom limb pain consented to provide clinical data and blood samples. One hundred forty participants with single or multiple limb amputation(s) were enrolled. The Visual analog scale and neuropathic pain symptom inventory were administered to evaluate the pain. Serum samples were analyzed for microRNA expression and bioinformatic analysis was performed. Sixty-seven participants did not experience phantom limb pain, whereas 73 participants experienced varying severities of phantom limb pain measured on a pain scale. Linear regression analysis suggested that the time since amputation is inversely related to severity of the pain. A significantly increased expression of 16 microRNAs was observed in participants experiencing phantom limb pain. Bioinformatic analysis shows a possible role of these microRNAs in regulating genes expressed in peripheral neuropathy. This study provides the first evidence of association of microRNA in phantom limb pain.

Visualizing the Unseen: Illustrating and Documenting Phantom Limb Sensations and Phantom Limb Pain With C.A.L.A.

Currently, there is neither a standardized mode for the documentation of phantom sensations and phantom limb pain, nor for their visualization as perceived by patients. We have therefore created a tool that allows for both, as well as for the quantification of the patient's visible and invisible body image. A first version provides the principal functions: (1) Adapting a 3D avatar for self-identification of the patient; (2) modeling the shape of the phantom limb; (3) adjusting the position of the phantom limb; (4) drawing pain and cramps directly onto the avatar; and (5) quantifying their respective intensities. Our tool (C.A.L.A.) was evaluated with 33 occupational therapists, physiotherapists, and other medical staff. Participants were presented with two cases in which the appearance and the position of the phantom had to be modeled and pain and cramps had to be drawn. The usability of the software was evaluated using the System Usability Scale and its functional range was evaluated using a self-developed questionnaire and semi-structured interview. In addition, our tool was evaluated on 22 patients with limb amputations. For each patient, body image as well as phantom sensation and pain were modeled to evaluate the software's functional scope. The accuracy of the created body image was evaluated using a self-developed questionnaire and semi-structured interview. Additionally, pain sensation was assessed using the SF-McGill Pain Questionnaire. The System Usability Scale reached a level of 81%, indicating high usability. Observing the participants, though, identified several operational difficulties. While the provided functions were considered useful by most participants, the semi-structured interviews revealed the need for an improved pain documentation component. In conclusion, our tool allows for an accurate visualization of phantom limbs and phantom limb sensations. It can be used as both a descriptive and quantitative documentation tool for analyzing and monitoring phantom limbs. Thus, it can help to bridge the gap between the therapist's conception and the patient's perception. Based on the collected requirements, an improved version with extended functionality will be developed.

Outcomes Of The Combined Anteroposterior Approach For Forequarter Amputation In Shoulder Girdle Tumours.

Forequarter amputation (FQA) is the surgical treatment of choice for tumours in the upper extremity and shoulder girdle that infiltrate the neurovascular bundle, shoulder joint and muscles of the shoulder girdle in non-salvageable cases. In both curative and palliative settings, FQA can serve as an effective oncological treatment for local control of tumour. All patients who underwent FQA in our unit from January 2016 till August 2019 for oncological indications were included in our study and their clinical outcomes were calculated. Thirteen patients were included in the study including 8 male patients. Mean age of patients at surgery was 20 years (Range 10-53 years) with a minimum follow up of 6 months or till patient was deceased earlier. Six patients had primary osteosarcoma, 4 had Ewing's sarcoma, 2 had Spindle cell sarcoma while 1 had Giant cell tumour. Six patients underwent surgery with curative intent. No major per operative complication was encountered in any of the cases with a mean blood loss of 350 ml and mean duration of surgery being 75 minutes. At last, follow up only 6 patients were alive, with 2 patients alive with disease (Metastasis) and undergoing palliative treatment. None of our patients had local recurrence. Mean survivorship for the whole cohort was 9.2 months (Range 3-18 months) with a mean survivorship for the deceased group was 7.1 months (Range 3-16 months) and mean survivorship for alive patients was 11.6 months (range 9-18 months). All the alive patients had phantom limb sensations and only one had a prosthesis in place only for cosmetic reasons, at last follow up. Although FQA is a significantly body disfiguring procedure, but in large tumours of shoulder girdle, this is a viable option for local control of the disease. Based on our study, although relatively small sample size, we propose the combined anteroposterior approach to be safe and reliable for advanced shoulder girdle tumours.

The Prevalence and Characteristics of Phantom Limb Pain and Non-Painful Phantom Phenomena in a Nationwide Survey of 3,374 Unilateral Limb Amputees

The experience of phantom limb pain (PLP) is a common consequence of limb amputation, resulting in severe impairments of the affected person. Previous studies have shown that several factors such as age at or site of amputation are associated with the emergence and maintenance of PLP. In this cross-sectional study we assessed the presence of several phantom phenomena including PLP and other amputation-related information in a sample of 3,374 unilateral upper and lower limb amputees. Clinical and demographic variables (age at amputation, level of amputation) explained 10.6% of the variance in PLP and perceptual variables (intensity of phantom limb sensation [PLS], referred sensations, intensity of telescoping, residual limb pain [RLP] intensity) explained 16.9% of the variance. These variables were specific for PLP and not for RLP. These results suggest that distinct variables are associated with PLP (age at amputation, level of amputation, PLS intensity, referred sensations, intensity of telescoping, RLP intensity) and RLP (PLP intensity) and point at partly different mechanisms for the emergence and maintenance of PLP and RLP. PerspectiveClinical/demographic variables as well as perceptual variables are 2 major components related to PLP and explain ∼11% and ∼17% of the variance. These results could potentially help clinicians to understand which factors may contribute to chronic phantom limb pain.