Introduction

Following lower-limb amputation, phantom limb pain (i.e., pain perceived as coming from the amputated portion of the limb) is common. Phantom limb pain may be associated with impaired body image and perception, which may be targets for rehabilitative intervention.

Objective

This study compared measures of body image and perception between adults with and without phantom limb pain post-amputation and evaluated associations between measures of body image and perception and phantom limb pain.

Design

Survey

Setting

Online, remote assessment.

Participants

Seventy-two adults ≥1-year post-unilateral lower-limb loss (n=42 with phantom limb pain, n=30 without phantom limb pain or pain in the remaining portion of the limb).

Interventions

Not applicable.

Main Outcome Measures

Self-reported outcome measures assessing body image (i.e., Amputee Body Image Scale-Revised), perceptual disturbances associated with the phantom limb (i.e., a modified BATH CRPS Body Perception Disturbance Scale), and prosthesis satisfaction (i.e., Trinity Amputation and Prosthesis Experience Scale) were administered; participants with phantom limb pain reported pain interference via the Brief Pain Inventory-Short Form. Between-group comparisons of self-reported outcome measure scores were conducted using Mann Whitney U or chi-square tests, as appropriate (a=0.05).

Results

Compared to peers without phantom limb pain, adults with phantom limb pain reported more negative body image; increased phantom limb ownership, attention, and awareness; and reduced prosthesis satisfaction and embodiment (U=175.50-364.00, p<0.001 to 0.034). Disturbances in phantom limb perception (i.e., size, weight, pressure, temperature) were similar between groups (p=0.086-1.000). More negative body image was associated with increased phantom limb pain interference (τb=0.25, p=0.026).

Conclusions

Adults with phantom limb pain demonstrate more negative body image and hypervigilance of the phantom limb as compared to peers with non-painful phantom sensations. Mind-body treatments that target impaired body image and perception may be critical interventions for adults with phantom limb pain.

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