Differences in phantom limb, residual limb, and bodily pain during pain recall and increasing activity intensity in persons with unilateral lower limb amputation

PM R. 2026 Feb 7. doi: 10.1002/pmrj.70096. Online ahead of print.

ABSTRACT

BACKGROUND: Pain is a common experience in the phantom limb, residual limb, and other parts of the body following amputation. However, formal pain surveys typically do not differentiate between these different pain subtypes, leading to a lack of relevant data to clinically diagnose patients' pain and provide targeted treatment.

OBJECTIVE: To characterize the phantom limb, residual limb, and bodily pain experiences and quality of life of patients with major lower limb amputation and compare these to self-evaluations of overall pain at time the survey, during the past month during rest, light daily activity, and maximal exertion to investigate prosthesis-related pains.

DESIGN: Cross-sectional within-participant study.

SETTING: Institutional secondary care.

PATIENTS: Eighty three adults with unilateral transfemoral or transtibial amputation with socket prostheses or bone-anchored limbs.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Overall, phantom limb, residual limb, and bodily pain evaluated at time of survey, averaged over past month, and during rest, light activity, and maximal activity.

RESULTS: Current and recalled residual limb pain intensity correlated with other pain subtypes for individuals with transfemoral socket prostheses (p ≤ .023), but not transfemoral bone-anchored limbs (p ≥ .064). Residual limb pain consistently correlated with current and recalled overall pain (p ≤ .037). More intense activity was correlated with higher pain intensity for individuals with transfemoral socket prostheses (p < .001), but phantom limb and bodily pains did not increase between rest and walking for individuals with transfemoral bone-anchored limbs (p ≥ .063).

CONCLUSIONS: Phantom limb, residual limb, and bodily pains contribute differently to the self-evaluation of overall pain, impact on quality of life, and challenge completing daily activities. Pain subtypes also differed between activity levels for individuals using socket prostheses but less so for those with bone-anchored limbs. Thus, pain subtypes should be evaluated simultaneously to provide a comprehensive assessment of patients' experiences with pain.

PMID:41653069 | DOI:10.1002/pmrj.70096