Prevalence and incidence of phantom limb pain, phantom limb sensations and telescoping in amputees: A systematic rapid review

Abstract

Background and objective: This systematic, rapid review aimed to critically appraise and synthesize the recent literature (2014-2019) evaluating the incidence and prevalence of post-amputation phantom limb pain (PLP) and sensation (PLS). Databases and data treatment: Five databases (Medline, Embase, Emcare, PsychInfo, Web of Science) and Google Scholar were searched, with two independent reviewers completing eligibility screening, risk of bias assessment and data extraction. Results: The search identified 1,350 studies with 12 cross-sectional and 3 prospective studies included. Studies evaluated traumatic (n = 5), atraumatic (n = 4), and combined traumatic/atraumatic (n = 6) amputee populations, ranging from 1 month to 33 years post-amputation. Study heterogeneity prevented data pooling. The majority of studies had a high risk of bias, primarily due to limited generalizability. Three studies evaluated PLP incidence, ranging from 2.2% (atraumatic; 1 month) to 41% (combined; 3 months) and 82% (combined; 12 months). Only one study evaluated PLS/telescoping incidence. Across contrasting populations, PLP point prevalence was between 6.7%-88.1%, 1 to 3-month period prevalence was between 49%-93.5%, and lifetime prevalence was high at 76%-87%. Point prevalence of PLS was 32.4%-90%, period prevalence was 65% (1 month) and 56.9% (3 months), and lifetime prevalence was 87%. Telescoping was less prevalent, highest among traumatic amputees (24.6%) within a 1-month prevalence period. Variations in population type (e.g. amputation characteristics) and incidence and prevalence measures likely influence the large variability seen here. Conclusions: This review found that lifetime prevalence was the highest, with most individuals experiencing some type of phantom phenomena at some point post-amputation.

Statistical analysis plan for an international, double-blind, randomized controlled clinical trial on the use of phantom motor execution as a treatment for phantom limb pain.

“…Patients' Global Impression of Change measured at visit 15 (single score [1][2][3][4][5][6][7]) PRI change between baseline and follow-up timepoints (1,3 and 6 months). PRI de ned as dichotomous variable indicating whether the patient has experienced a clinically meaningful reduction in pain (achieved with a decrease 50% or more [23], [24] of the PRI).…”

“…Weighted Pain Distribution Index (range [1][2][3][4][5]): sum of the scores given to pain ratings during the day, weighted by the amount of time spent in the respective level of pain [16].…”

“…Phantom limb pain (PLP) is a subtype of post-amputation pain with prevalence between 17% and 88% by one meta-analysis study [2] and lifetime prevalence between 76%-87% by another recent systematic review [3]. A wide range of treatment methods for the condition has been proposed over the years [4], [5], however reviews and surveys have repeatedly stressed that there is little evidence from appropriate randomized controlled trials (RCTs) to guide treatment choice, be it pharmacological or non-pharmacological [6]- [9].…”

Early life experience sets hard limits on motor learning as evidenced from artificial arm use

“…It therefore stands to reason that in comparison to the acquired group, who only begin to learn to use their artificial arm as adults (in our sample at a mean age of 32), the congenital group should have had more time and practice in early childhood to perfect their artificial arm motor skill. Moreover, individuals with an acquired limb-difference often experience a 'phantom hand' (Stankevicius et al, 2020), rooted in a maintained representation of their missing arm (Bruurmijn et al, 2017;Kikkert et al, 2016;Wesselink et al, 2019) which might in theory interfere with the acquisition of a representation of an arm substitute (the artificial arm). Perhaps most importantly, relative to individuals with an acquired limbdifference, individuals with a congenital limb-difference tend to make better use of their artificial arm in daily life (Biddiss & Chau, 2007).…”

Early life experience sets hard limits on motor learning as evidenced from artificial arm use

“…It therefore stands to reason that in comparison to amputees, who only begin to learn to use their artificial arm as adults (in our sample at a mean age of 32), one-handers should have had more time and practice in early childhood to perfect their artificial arm motor skill. Moreover, amputees often experience a 'phantom hand' (Stankevicius et al, 2020), rooted in a maintained representation of their missing arm (Bruurmijn et al, 2017;Kikkert et al, 2016;Wesselink et al, 2019) which might in theory interfere with the acquisition of a representation of an arm substitute (the artificial arm). Perhaps most importantly, relative to amputees, one-handers tend to make better use of their artificial arm in daily life (Biddiss & Chau, 2007).…”