Post-Amputation Pain Is Associated with the Recall of an Impaired Body Representation in Dreams—Results from a Nation-Wide Survey on Limb Amputees

Abstract

The experience of post-amputation pain such as phantom limb pain (PLP) and residual limb pain (RLP), is a common consequence of limb amputation, and its presence has negative effects on a person’s well-being. The continuity hypothesis of dreams suggests that the presence of such aversive experiences in the waking state should be reflected in dream content, with the recalled body representation reflecting a cognitive proxy of negative impact. In the present study, we epidemiologically assessed the presence of post-amputation pain and other amputation-related information as well as recalled body representation in dreams in a sample of 3,234 unilateral limb amputees. Data on the site and time of amputation, residual limb length, prosthesis use, lifetime prevalence of mental disorders, presence of post-amputation pain, and presence of non-painful phantom phenomena were included in logistic regression analyses using recalled body representation in dreams (impaired, intact, no memory) as dependent variable. The effects of age, sex, and frequency of dream recall were controlled for. About 22% of the subjects indicated that they were not able to remember their body representation in dreams, another 24% of the amputees recalled themselves as always intact, and only a minority of less than 3% recalled themselves as always impaired. Almost 35% of the amputees dreamed of themselves in a mixed fashion. We found that lower-limb amputation as well as the presence of PLP and RLP was positively associated with the recall of an impaired body representation in dreams. The presence of non-painful phantom phenomena, however, had no influence. These results complement previous findings and indicate complex interactions of physical body appearance and mental body representation, probably modulated by distress in the waking state. The findings are discussed against the background of alterations in cognitive processes after amputation and hypotheses suggesting an innate body model.

When less is more – Implicit preference for incomplete bodies in xenomelia

“…Age-and sex-matched control participants with an amputation were recruited using the database created for a previous comprehensive study about body representation in amputees (e.g. Bekrater-Bodmann et al, 2015).…”

“…Based on previous reviews and finding regarding recalled body representation in dreams in amputees (Bekrater-Bodmann et al, 2015;Brugger, 2008), participants were asked to rate how often they recalled their body during dreams as complete or incomplete on a numerical rating scale from 0 (never) to 20 (always). The difference between these two ratings was computed and normalized so that it ranged from -1 (very often incomplete and never complete) to 1 (very often complete and never incomplete).…”

A review of current theories and treatments for phantom limb pain

“…After limb amputation, an individual's cortical and peripheral body representations remain intact, but no longer correspond, and this mismatch is enhanced by a lack of visual feedback from the missing limb, thus generating excessive pain, in spite of the lack of a sensory stimulus (20). A study investigating the relationship between body representation within a dream and the experience of PLP found a positive correlation between increased PLP after lower limb amputation and the ability to recall intact body representations (21). These findings suggest that aversive somatosensory experiences mediate the skewed interactions between mental and physical body representations, which then facilitate PLP (21).…”

Phantom limb pain intensity is associated with generalized hyperalgesia

“…3 Side of amputation in the HC (in brackets) refers to the side of amputation of the matched amputee. 4 The category "other" causes of amputation subsumes all causes not falling into the categories traumatic, injury, dysplasia, infection, tumor or vascular disease. 5 Pain severity subscale of the MPI adapted for PLP and RLP respectively.…”

“…The degree of telescoping as well as type, duration and frequency of prosthesis use were assessed using a standardized interview 69,16 . Embodiment of the prosthesis was assessed using a numerical rating scale ranging from 0 ("feels like a foreign object") to 10 ("feels like part of my body") included in the nation-wide survey 4 . Compensatory hand use was assessed with an additional questionnaire 16,43 .…”