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Phantom Limb, Residual Limb, and Back Pain After Lower Extremity Amputations.

Smith, Douglas G. MD*,**†; Ehde, Dawn M. PhD**‡; Legro, Marcia W. PhD§; Reiber, Gayle E. PhD∥¶; del Aguila, Michael PhD∥¶; Boone, David A. CP, MPH*†‡#

Section Editor(s): Gottschalk, Frank MD

Clinical Orthopaedics & Related Research: April 1999 - Volume 361 - Issue - pp 29-38
Section I: Symposium: Amputation and New Prosthetic Devices

This study describes the sensations and pain reported by persons with unilateral lower extremity amputations. Participants (n = 92) were recruited from two hospitals to complete the Prosthesis Evaluation Questionnaire which included questions about amputation related sensations and pain. Using a visual analog scale, participants reported the frequency, intensity, and bothersomeness of phantom limb, residual limb, and back pain and nonpainful phantom limb sensations. A survey of medication use for each category of sensations also was included. Statistical analyses revealed that nonpainful phantom limb sensations were common and more frequent than phantom limb pain. Residual limb pain and back pain were also common after amputation. Back pain surprisingly was rated as more bothersome than phantom limb pain or residual limb pain. Back pain was significantly more common in persons with above knee amputations. These results support the importance of looking at pain as a multidimensional rather than a unidimensional construct. They also suggest that back pain after lower extremity amputation may be an overlooked but very important pain problem warranting additional clinical attention and study.

From the Departments of *Orthopaedic Surgery, ∥Health Services and Epidemiology, and ‡Rehabilitation Medicine, University of Washington, Seattle, WA; ¶Veterans Administration Puget Sound Health Care System, Seattle, WA; **Harborview Medical Center, Seattle, WA; †Prosthetics Research Study, Seattle, WA; §MEDTAP International Inc, Seattle, WA; and the #Veterans Administration Center for Amputation, Prosthetics and Limb Loss Prevention, Seattle, WA.

Supported by grants from Department of Veterans Affairs, Health Services Research and Development, and Rehabilitation Research and Development; and the Prosthetics Research Study.

Reprint requests to Douglas G. Smith, MD, Department of Orthopaedics, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104-2499.

© 1999 Lippincott Williams & Wilkins, Inc.