Chronic Pain Associated with Upper-Limb Loss

Hanley MA, Ehde DM, Jensen M, Czerniecki J, Smith DG, Robinson LRChronic pain associated with upper-limb loss. OBJECTIVE:To describe the prevalence, intensity, and functional impact of the following types of pain associated with upper-limb lossphantom limb, residual limb, back, neck, and nonamputated-limb pain. DESIGN:Cross-sectional survey; 104 respondents with upper-limb loss at least 6 months postamputation completed measures of pain intensity, interference, disability, and health-related quality-of-life. RESULTS:Nearly all (90%) of the respondents reported pain, with 76% reporting more than one pain type. Phantom-limb pain and residual-limb pain were the most prevalent (79% and 71%, respectively), followed by back (52%), neck (43%), and nonamputated-limb pain (33%). Although nonamputated-limb pain was least prevalent, it was reported to cause the highest levels of interference and pain-related disability days. Self-reported quality-of-life was significantly lower for individuals with each type of pain compared with those without any pain. Age, time since amputation, and cause of amputation were not associated with pain. CONCLUSIONS:In addition to pain in the phantom and residual limb, back, neck, and nonamputated-limb pain are also common after upper-limb loss. All of these pain types are associated with significant disability and activity interference for some individuals, suggesting that assessment of multiple pain types in persons with upper-limb amputation may be important.