Psychological Distress in Amputees with Phantom Limb Pain

Abstract

Research suggesting that psychological factors play a role in phantom limb pain abounds in the literature. Despite recent research suggesting that these factors exacerbate rather than cause phantom limb pain, clinicians still frequently use personality as a rationale to explain amputees' phantom limb pain. The present study aimed to examine psychological distress in a working-age population of amputees not specifically seeking help for their pain. The study was conducted in two phases. Phase 1 included 315 amputees who completed the General Health Questionnaire (GHQ). Phase 2 included a subset of the original sample who completed the Beck Depression Inventory (BDI). In Phase 1, although over 50% of the sample reported GHQ scores over the threshold used to detect "caseness," this was not related to phantom limb pain. In Phase 2 of the study, only 15% of the sample reported moderate to severe symptoms of depression. Only 4% of the variance in phantom limb pain was accounted for using the overall BDI score. When BDI items were examined individually within regression models, a number significantly predicted phantom limb pain. However, the items most related to phantom limb pain were those involved in "performance difficulties" rather than "negative affect." The present study suggests that negative affect in amputees may be related to disability rather than pain.

The relationship between prosthesis use, phantom pain and psychiatric symptoms in male traumatic limb amputees

“…There are studies regarding the association between phantom pain and anxiety/depression. Some of these have reported higher anxiety and depression symptoms in subjects with phantom pain (22,(39)(40)(41)(42) while others maintain there is no correlation (14,21,31,(43)(44)(45)(46). One review study reported that findings in the literature regarding the relation between phantom pain and anxiety/depression are inconsistent (29).…”

Psychosocial adjustment to lower-limb amputation: A review

“…78 However, only two studies have actually reported any significant relationship between body image anxiety and PLP. 79,80 Without speculating as to the precise direction of the relationship, one study 79 found that participants with phantom pain were significantly more likely to draw intact body image drawings than were participants without phantom pain. In addition, a second study 80 found that body image anxiety items from the Beck Depression Inventory accounted for 16% of the variance in phantom pain intensity.…”

“…81 -88 Although the above findings indicate some relationship between stress and phantom limb pain, the findings relating anxiety and/or depression to phantom pain have been mixed. Some cross-sectional studies 78,80,89 have found an association between duration or occurrence of phantom pain and depression. However, others have found no difference between those with and without such pain and levels of anxiety 6 or depression.…”

Phantom limb phenomenon as an example of body image distortion

“…There are many factors which are perceived to be associated with phantom pain occurrence and development, such as age, prosthetic use, time elapsed since amputation or sex [19]. Apart from its prevalence, phantom pain is discussed in terms of its frequency in a single patient, duration, intensity and qualitative descriptors [13,[15][16][17][20][21][22][23][24][25]. Phantom pain may change its intensity or quality or even disappear over time [15].…”