Cross-Sectional Assessment of Factors Related to Pain Intensity and Pain Interference in Lower Limb Prosthesis Users.

The study was cross-sectional, so it cannot show that pain sites caused higher interference or that prosthetic use reduced pain. Participants were not randomly sampled and were recruited through advertisements and mailings, so the sample may not represent all lower-limb prosthesis users. The sample had fewer people with dysvascular amputation, 42.3%, than estimated in the U.S. lower-limb amputation population, about 80%. Only people who could read, write, and understand English and regularly use a prosthesis to walk were eligible, so results may not apply to non-users or people with other language needs. Pain-site questions were added for this survey and were not tested with cognitive interviews, so 'problematic' may have been interpreted differently. The survey did not ask about pain medication, frequency, or intensity of individual pain sites, which limits comparison with other studies. Pain-site data were missing for fewer than 9% of participants, leaving 1174 for regression models. Four participants in the pain interference model and six in the pain intensity model were removed as unusual and potentially influential.

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Do not read the link between more prosthetic-use hours and lower pain scores as proof that using the prosthesis more reduces pain. The study was cross-sectional, so pain may have limited use instead. Also, multiple pain sites were linked to worse scores, so one site alone does not explain the pain.