Psychological factors influencing chronic phantom limb pain: An analysis of the literature

Abstract

The behavioral literature concerning chronic phantom limb pain was reanalyzed in order to determine the role of psychological factors in initiating and controlling the intensity of its episodes. Some of the behavioral literature presents an inaccurate picture of amputees who have phantom pain. This apparently happened because many of the data were gathered from those amputees requesting treatment for phantom pain who were referred to mental health professionals. We conclude that phantom pain is similar to other chronic pain syndromes in that episodes are greatly influenced by psychological factors such as stress and depression. Repeated requests for treatment are influenced by personality structure. There is no convincing evidence that major personality disorders are important in the etiology of chronic phantom pain nor that they are more prevalent among those amputees reporting phantom pain than among those not reporting it.

Psychophysiological Contributions to Phantom Limbs

“…Depression (71)(72)(73)(74), anxiety (74,75) and other forms of psychopathology are common (74)(75)(76)(77). Moreover, amputees with severe phantom limb pain score higher on psychological inventories measuring depression (72) and neuroticism (76) than amputees who have little or no pain.…”

“…He appears to have a compulsive need to do everything at least as well as he could before operation and if possible, better, as if to convince himself and everyone else that he is not incapacitated at all." With the exception of a recent review (73), the idea that patients with persisting phantom limb pain are rigid and exhibit compulsively self-reliant personality characteristics has been uncritically accepted by researchers and clinicians (74,(88)(89)(90), despite the absence of empirical evidence.…”

“…In many instances an association between pain and psychological distress (for example, depression and anxiety) or particular personality traits or styles (for example, rigidity and compulsive self-reliance) is influenced by biased sampling procedures so that the characteristics of a select group of patients (for example, those referred to a pain centre) come to define the population at large (73,91). Sherman et al (73) suggest that the low success rate of most treatments for phantom limb pain deters all but the most persistent or selfreliant patients.…”

“…Sherman et al (73) suggest that the low success rate of most treatments for phantom limb pain deters all but the most persistent or selfreliant patients. Long after less assertive patients have given up actively seeking help, these sufferers continue to search for relief despite repeated failures.…”

A Predictive Model of Occupational and Lifestyle Risk Factors and Pain Management Strategies for Participants in a Wellness Program Diagnosed with Chronic Low Back Pain

“…Based on the possible relationships between occupational and lifestyle risk factors and the potential effects associated with CLBP as revealed in this study, people diagnosed by a doctor with CLBP were more likely to have low back pain in the past, may have had a previous low back injury caused from LTB and/or STF [71]. They tend to take steps at home to treat CLBP [72]; have chronic health conditions such as chronic insomnia, arthritis, high blood pressure, high cholesterol, or heart disease [73]; have much bodily pain and more than one ongoing problem (wrist pain, tingling or numbness, neck pain and eye strain) that interferes with their daily activity [74]; have more daily stressors such as personal illness or injury, family problems, financial problems [75]; experience more emotional problems [42] such as anxiety, depression or irritability [76]; have a physical condition that limits their ability to get enough exercise and complete physical activities [77].…”