The experience of phantom limb pain in patients with combat-related traumatic amputations

Objectives: To describe the prevalence and characteristics of phantom limb pain (PLP) and the use and perceived effectiveness of standard medical and self-treatment methods by traumatic amputees with combat-related injuries. Design: A retrospective descriptive questionnaire study. Setting: Outpatient amputee clinic at a major military medical center. Participants: Convenience sample of military members (N=30) with single or multiple traumatic amputations from combat and/or training. Inclusion criteria were 18 to 50 years old and amputation within 5 years of the study. Exclusion criteria were nontraumatic amputees and amputation or most recent surgical revision within 3 months before the study. Interventions: Not applicable. Main Outcome Measures: The primary dependent variables were pain and relief, as measured by an investigator-developed questionnaire. Results: Seventy-seven percent of participants experienced PLP at some time since their amputation. Of those with PLP, the mean average intensity was 3.3 +/- 2.0 out of 10 and the mean worst intensity was 5.4 +/- 2.6 out of 10. The PLP was intermittent, and 78% reported episodes of PLP at least weekly. Sixty-eight percent of participants with PLP were receiving treatment from their health care providers. The most common medical treatment was gabapentin, although some patients reported greater pain relief from self-treatment methods such as distraction and relaxation techniques. Conclusions: With over 750 service members living with amputations from recent combat, PLP will continue to be a troubling problem that requires effective interventions. The discrepancy between perceived effectiveness of different treatment types supports the need for highly individualized pain management plans.