Immediate and long-term phantom limb pain in amputees: Incidence, clinical characteristics and relationship to pre-amputation limb pain

TLDR

The study prospectively interviewed 58 limb‑amputation patients pre‑operatively and at 8 days, 6 months, and 2 years post‑operatively to assess pre‑amputation limb pain, stump pain, and phantom‑limb pain. In this cohort, pre‑amputation limb pain was nearly universal, phantom‑pain incidence was 72 %, 65 %, and 59 % at 8 days, 6 months, and 2 years respectively, was more frequent early on in those with long‑lasting or immediate pre‑amputation pain, with similar localization and character to pre‑amputation pain in 36 % immediately after but only 10 % later, while stump‑pain incidence fell from 57 % to 21 % over two years, suggesting pre‑operative pain predicts early but not persistent phantom pain.

Abstract

In a prospective study 58 patients undergoing limb amputation were interviewed the day before operation about their pre-amputation limb pain and 8 days, 6 months and 2 years after limb loss about their stump and phantom limb pain. All but one patient had experienced pain in the limb prior to amputation. Pre-amputation limb pain lasted less than 1 month in 25% of patients and more than 1 month in the remaining 75% of patients. At the first examination the day before amputation 29% had no limb pain. The incidence of phantom pain 8 days, 6 months and 2 years after amputation was 72, 65 and 59%, respectively. Within the first half year after limb loss phantom pain was significantly more frequent in patients with long-lasting pre-amputation limb pain and in patients with pain in the limb immediately prior to amputation. Phantom pain and pre-amputation pain were similar in both localization and character in 36% of patients immediately after amputation but in only 10% of patients later in the course. Both the localization and character of phantom pain changed within the first half year; no further change occurred later in the course. The incidence of stump pain 8 days, 6 months and 2 years after limb loss was 57, 22 and 21%, respectively. It is suggested that preoperative limb pain plays a role in phantom pain immediately after amputation, but probably not in late persistent phantom pain.