Background & Aims
Approximately 80% of individuals who have sustained limb loss experience phantom limb pain (PLP) and/or residual limb pain (RLP) [1]. These individuals may also report the presence of ‘telescoping’, described as the experience of the phantom limb gradually retracting towards the residual limb giving the impression of a shorter-than-normal phantom [2]. Telescoping is endorsed by roughly one-third of those who have had an amputation yet correlates with telescoping are not well understood [3]. Clinicians and researchers have drawn attention to the need to further understand its relationship to post-amputation pain. The current study aims to explore the association between telescoping and various factors including sex, cause of amputation, ongoing PLP and/or RLP, and symptoms of depression and anxiety in a heterogenous sample of adults who have undergone amputation of a limb.
Methods
A total of 47 individuals with limb loss (17 women; n = 6, upper limb; n = 41, lower limb) were recruited into the study. Participants had undergone amputation of a limb at least 3 months previous to completing online questionnaires reporting demographic variables, experience of telescoping (yes/no), reason for amputation (trauma, cancer, diabetes, non-diabetic vascular, other), ongoing pain problems (yes/no), and depression and anxiety symptom severity (Patient Health Questionnaire 4; PHQ-4, scored as normal, mild, moderate, severe). Chi-square tests were conducted to examine between-group differences for those who endorsed telescoping and those who did not for reported sex (male/female), cause of amputation, ongoing pain problems, and severity of depression and anxiety symptoms using Bonferroni-corrected post-hoc analyses. P<0.05 is considered statistically significant.
Results
Of the 47 participants, 37 reported RLP, 31 reported PLP, and 20 reported telescoping over the past week. A significant association was not found between telescoping and sex or ongoing pain symptoms. Telescoping was significantly associated with amputation etiology, X^2(4, 47)=9.6, p=.048, whereby those who reported telescoping were more likely to have lost their limb from trauma than those who did not report telescoping. Moreover, a significantly greater proportion of individuals who did not experience telescoping versus those who did lost their limb because of diabetes-related concerns. Additionally, telescoping was significantly associated with severity of depression and anxiety symptoms, X^2(3, 46)=9.44, p=.024. A significantly greater proportion of individuals who did not endorse telescoping versus those who did fell in the “normal” range. In contrast, a significantly greater proportion of individuals who endorsed telescoping versus those who did not fell in the “severe” range.
Conclusions
The results suggest that telescoping is not related to sex or ongoing pain experience. The reason for amputation may be related to telescoping status, and the current results are consistent with other findings suggesting that telescoping is more common in those who lost their limb due to trauma and less common in those who lost their limb from diabetes-related conditions [4]. Additionally, telescoping may be associated with increased severity of depression and anxiety symptoms given that individuals who endorse telescoping report more severe symptoms. Further research using a larger sample size is needed to replicate these results. Longitudinal studies are required to understand the direction of the relationship between telescoping and symptoms of anxiety and depression.
References
[1] Richardson, C., & Kulkarni, J. (2017). A review of the management of phantom limb pain: challenges and solutions. J Pain Res, 10, 1861-1870. https://doi.org/10.2147/JPR.S124664
[2] Katz, J., & Melzack, R. (2003). Phantom pain. In Handbook of Neuropsychology (Vol. Vol. 9, pp. pp. 205-230). Oxford: Elsevier Press.
[3] Hill, A. (1999). Phantom limb pain: a review of the literature on attributes and potential mechanisms. J Pain Symptom Manage, 17(2), 125-142. https://doi.org/10.1016/s0885-3924(98)00136-5
[4] Stankevicius, A., Wallwork, S. B., Summers, S. J., Hordacre, B., & Stanton, T. R. (2021). Prevalence and incidence of phantom limb pain, phantom limb sensations and telescoping in amputees: A systematic rapid review. European Journal of Pain, 25(1), 23-38.
Presenting Author
Andrea Aternali
Poster Authors
Andrea Aternali
BSc
York University
Lead Author
Heather Lumsden-Ruegg
BA
York University
Lead Author
Sander L. Hitzig
PhD
Sunnybrook Research Institute, St. John’s Rehab Research Program
Lead Author
Amanda L. Mayo
MD
Sunnybrook Health Sciences Centre
Lead Author
Joel Katz
PhD
York University
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Pain in Amputees