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.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Current estimates from the National Health Interview Survey, 1996. National Center for Health Statistics, Bethesda1999
- Phantom limb, residual limb, and back pain after lower extremity amputations.Clin Orthop. 1999; (Apr): 29-38
- Phantom limbs and related phenomenon in recent traumatic amputations.Neurology. 1978; 28: 211-217
- Phantom limb.Br J Psychiatry. 1982; 141: 54-58
- A five year follow-up study of phantom limb pain in post traumatic amputees.Scand J Rehabil Med. 1982; 14: 203-207
- Prevalence and characteristics of chronic phantom limb pain among American veterans. Results of a trial survey.Am J Phys Med. 1983; 62: 227-238
- Chronic phantom and stump pain among American veterans.Pain. 1984; 18: 83-95
- Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation.Pain. 1983; 17: 243-256
- Non-painful phantom limb phenomena in amputees.Acta Neurol Scand. 1984; 70: 407-414
- Immediate and long-term phantom limb pain in amputees.Pain. 1985; 21: 267-278
- Does preamputation pain influence phantom limb pain in cancer patients?.South Med J. 1985; 78: 34-36
- Phantom pain.Ann R Coll Surg Engl. 1994; 76: 22-25
- Phantom pain and sensation among British veteran amputees.Br J Anaesth. 1997; 78: 652-659
- Phantom pain and phantom sensations in upper limb amputees.Pain. 2000; 87: 33-41
- Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation.Arch Phys Med Rehabil. 2000; 81: 1039-1044
- Phantom limb pain and residual limb pain following lower limb amputation.Disabil Rehabil. 2001; 23: 522-530
- Factors determining the persistence of phantom limb pain in the amputee.J Psychosom Res. 1973; 17: 97-108
- Evaluation of problems and needs of veteran lower-limb amputees in the San Francisco Bay Area during the period 1977–1980.J Rehabil Res Dev. 1983; 20: 57-71
- Back pain as a secondary disability in persons with lower limb amputations.Arch Phys Med Rehabil. 2001; 82: 731-734
- Pain after amputation.in: Loeser J. Butler S. Chapman C. Bonica’s management of pain. Lippincott Williams & Wilkins, Philadelphia2001: 412-423
- Effects of nervous system lesions on phantom experience in amputees.Neurology. 1969; 19: 141-146
- The influence of preamputation pain on postamputation stump and phantom pain.Pain. 1997; 72: 393-405
- Pain site and impairment in individuals with amputation pain.Arch Phys Med Rehabil. 2002; 83: 1116-1119
- Psychosocial predictors of physical performance in disabled individuals with chronic pain.Clin J Pain. 2003; 19: 18-30
- Factors related to successful job reintegration of people with a lower limb amputation.Arch Phys Med Rehabil. 2001; 82: 1425-1431
- A preliminary examination of the relationship between employment, pain and disability in an amputee population.Disabil Rehabil. 2002; 24: 462-470
- A review of employment patterns of industrial amputees—factors influencing rehabilitation.Prosthet Orthot Int. 1985; 9: 69-78
- A comparison of psychosocial functioning and personality in amputee and chronic pain populations.Clin J Pain. 1992; 8: 351-357
- Depression among amputees.J Clin Psychiatry. 1983; 44: 256-258
- Depression in men with traumatic lower part amputation.Mil Med. 2003; 168: 106-109
- Epidemiologic evidence on the comorbidity of depression and diabetes.J Psychosom Res. 2002; 53: 903-906
- The prevalence and distribution of major depression in a national community sample.Am J Psychiatry. 1994; 151: 979-986
- Psychological response to amputation as a function of age and time since amputation.Br J Psychiatry. 1984; 144: 493-497
- Psychosocial adaptation to amputation.Int J Rehabil Res. 1999; 22: 21-31
- The central role of restricted normal activities in adjustment to illness and disability.Rehabil Psychol. 1998; 43: 327-347
- Pain site and the effects of amputation pain.Pain. 2001; 91: 317-322
- Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index.J Aging Health. 1993; 5: 179-193
- Reliability and validity of screening scales.J Clin Epidemiol. 1989; 42: 69-78
- Poverty 2000. Census Bureau, Washington (DC)2004
- The long-term outcome of upper limb amputees treated at a rehabilitation centre in Sydney, Australia.Disabil Rehabil. 1995; 17: 437-442
- Painful neuromata following upper limb amputation.Prosthet Orthot Int. 1996; 20: 176-181
- The relationship of phantom limb pain to other phantom limb phenomena in upper extremity amputees.Pain. 1997; 72: 87-93
- Summary health statistics for U.S. adults.Vital Health Stat 10. 2002; : 1-113
Article info
Footnotes
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.
Identification
Copyright
© 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
