Phantom pain, residual limb pain, and back pain in amputees: Results of a national survey

Objectives: To describe the prevalence of amputation-related pain; to ascertain the intensity and affective quality of phantom pain, residual limb pain, back pain, and nonamputated limb pain; and to identify, the role that demographics, amputation-related factors, and depressed mood may contribute to the experience of pain in the amputee. Design: Cross-sectional survey. Setting: A sample of persons who contacted the Amputee Coalition of America from 1998 to 2000 were interviewed by telephone. Participants: A stratified sample by etiology of 914 persons with limb loss. Interventions: Not applicable. Main Outcome Measures: Prevalence, intensity, and bothersomeness of residual, phantom, and back pain, depressed mood as measured by the Center for Epidemiologic Study Depression Scale, characteristics of the amputation, prosthetic use, and sociodemographic characteristics of the amputee, Results: Nearly all (95%) amputees surveyed reported experiencing I or more types of amputation-related pain in the previous 4 weeks. Phantom pain was reported most often (79.9%), with 67.7% reporting residual limb pain and 62.3% back pain. A large proportion of persons with phantom pain and stump pain reported experiencing severe pain (rating 7-10). Across all pain types, a quarter of those with pain reported their pain to be extremely bothersome. Identifiable risk factors for intensity and bothersomeness of amputation-related pain varied greatly by pain site. However, across all pain types, depressive symptoms were found to be a significant predictor of level of pain intensity and bothersomeness. Conclusions: Chronic pain is highly prevalent among persons with limb loss, regardless of time since amputation. A common predictor of an increased level of intensity and bothersomeness among all pain sites was the presence of depressive symptoms. Further studies are needed to elucidate the relationship between pain and depressive symptom among amputees.