Phantom limb syndrome: Assessment of psychiatric and medical comorbidities associated with Phantom pain in 44,028 below knee amputees

William B Hogan; George Anderson; Matthew Kovoor; Daniel Alsoof; Christopher L McDonald; Andrew S Zhang; Eren O Kuris; Joey P Johnson; Alan H Daniels

doi:10.1016/j.injury.2022.09.018

Phantom limb syndrome: Assessment of psychiatric and medical comorbidities associated with Phantom pain in 44,028 below knee amputees

Injury. 2022 Nov;53(11):3697-3701. doi: 10.1016/j.injury.2022.09.018. Epub 2022 Sep 13.

Authors

William B Hogan¹, George Anderson¹, Matthew Kovoor¹, Daniel Alsoof², Christopher L McDonald³, Andrew S Zhang³, Eren O Kuris³, Joey P Johnson⁴, Alan H Daniels⁵

Affiliations

¹ Warren Alpert Medical School of Brown University, Providence, RI, United States.
² Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, RI, United States.
³ Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, RI, United States.
⁴ Department of Orthopedics, University of Alabama at Birmingham, Birmingham, AL, United States.
⁵ Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, RI, United States. Electronic address: alan_daniels@brown.edu.

PMID: 36163201
DOI: 10.1016/j.injury.2022.09.018

Abstract

Introduction: Phantom limb syndrome is a debilitating complication after extremity amputation that poses significant challenges to recovery. This study aims to examine the relationship between phantom limb syndrome and mental and physical comorbidities, including a comparison between phantom limb pain and phantom limb syndrome without pain in below knee amputees.

Methods: This is a retrospective cohort study of patients who underwent below knee amputation of the lower extremity in the PearlDiver database, as identified using CPT codes. Analysis was carried out to evaluate the absence or presence of phantom limb syndrome. Matched bivariate analysis accounting for age, sex, Charlson Comorbidity Index score, and region was used to assess whether the presence of pain in phantom limb syndrome patients was associated with increased comorbidity.

Results: In total, 44,028 patients with below knee amputation were examined: 95% (42,493 patients) did not develop phantom limb syndrome while 4.8% (1,535 patients) of patients did develop phantom limb syndrome. Phantom limb syndrome was significantly associated with increased odds of coexistent major depressive disorder (OR = 1.86, p <0.0001), generalized anxiety disorder (OR = 2.14, p = 0.04), posttraumatic stress disorder (OR = 1.7, p <0.0001), suicidal ideation (OR = 1.62, p <0.0001), obesity (OR = 1.28, p = 0.0007), osteoarthritis (OR = 1.53, p <0.0001), osteoporosis (OR = 1.64, p <0.0001), and low back pain (OR = 2.31, p <0.0001). Analysis of patient cohorts of phantom limb syndrome with pain and those without pain did not reveal a statistically significant relationship between the presence of pain and any dependent variable.

Conclusions: This investigation of over 44,000 patients with below knee amputation revealed that patients with phantom limb syndrome exhibit significantly higher rate of psychiatric comorbidities compared to those without documented phantom limb pain. Suicidal ideation, major depressive disorder, generalized anxiety disorder, and post-traumatic stress disorder were especially common, and consequently a multi-disciplinary approach to management is essential.

Keywords: Amputation; Comorbidities; Medical; Phantom limb syndrome; Psychiatric.

MeSH terms

Amputees* / psychology
Comorbidity
Depressive Disorder, Major*
Humans
Lower Extremity
Phantom Limb* / epidemiology
Phantom Limb* / etiology
Phantom Limb* / psychology
Retrospective Studies