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. 2023 Mar;15(3):278-290.
doi: 10.1002/pmrj.12750. Epub 2022 Feb 9.

Body image and perception among adults with and without phantom limb pain

Emma Haldane Beisheim-Ryan  1 , Gregory Evan Hicks  1 , Ryan Todd Pohlig  2 , Jared Medina  3 , Jaclyn Megan Sions  1
Affiliations

Body image and perception among adults with and without phantom limb pain

Emma Haldane Beisheim-Ryan et al. PM R. 2023 Mar.

Abstract

Background: 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: To compare measures of body image and perception between adults with and without phantom limb pain post amputation and evaluate 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 Complex Regional Pain Syndrome 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 = .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 < .001 to .034). Disturbances in phantom limb perception (i.e., size, weight, pressure, temperature) were similar between groups (p = .086 to >.999). More negative body image was associated with increased phantom limb pain interference (τb = .25, p = .026).

Conclusions: Adults with phantom limb pain demonstrate more negative body image and hypervigilance of the phantom limb as compared to peers with nonpainful 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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Conflict of interest statement

Conflicts of Interest: None to report.

Figures

Figure 1.
Figure 1.
A proposed model depicting the cyclic relationship between PLP and body image and perception. To provide support to underlying relationships among PLP, body image, and body perception proposed in this preliminary model, this study investigated whether PLP characteristics (i.e., pain intensity, pain interference) are associated with negative body image and distorted body perceptions, incuding phantom limb hypervigilance (denoted in black). If present, these associations may lay critical groundwork for future studies investigating further relationships between body image and perception and impaired pain processing (in grey), including cognitive pain responses (e.g., pain catastrophizing and other pain-related thought patterns) and emotions (e.g., sadness, shame, stress).
Figure 2.
Figure 2.
Participant inclusion.
Figure 3.
Figure 3.
Examples of phantom limb perceptual disturbances among adults with and without PLP.
See this image and copyright information in PMC

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