Identifying discriminant factors between phantom limb pain, residual limb pain, and both in people with lower limb amputations: a cross-sectional study.
Sanaz Pournajaf, Carlo Damiani, Francesco Agostini and 5 others
PMID 38995163WHAT IT FOUND
People with above-knee amputations had 2.7 times higher odds of phantom limb pain alone compared to those with below-knee amputations.
However, having both phantom and residual limb pain did not worsen functional independence or walking participation compared to having just one type of pain.
Key findings
01Transfemoral (above-knee) amputation was the only significant predictor of pain type, increasing the odds of experiencing phantom limb pain alone versus both types of pain by 2.7 times compared to transtibial (below-knee) amputation.
02There was no statistically significant difference in pain intensity, functional independence, or walking participation between people experiencing phantom limb pain, residual limb pain, or both types of pain simultaneously.
03Among the total sample, 31% experienced both types of pain, 27% experienced phantom limb pain, 10% experienced residual limb pain, and 32% reported no pain.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study is cross-sectional, so it cannot determine causality or how pain types change over time. The Modified Rankin Scale was originally designed for stroke patients, and its validity for assessing functional independence in people with lower limb amputation is not firmly established. Psychological factors such as depression, which can influence pain perception and function, were not assessed. The analysis of pain types was restricted to the 192 participants who reported pain, excluding the 90 who reported none, which may limit generalizability regarding the entire amputee population. Prosthesis use was self-reported and binary (yes/no), without detail on fit or comfort, which are known contributors to residual limb pain.
Declared interests
The authors declared no conflicts of interest. The study was approved by the local ethics committee.
The easy way to misread this
Do not conclude that patients with both phantom and residual limb pain are more disabled than those with one type. The study found no significant difference in functional independence or walking participation between these groups, meaning pain type alone does not predict functional status.