Period Prevalence Surveys: A New Approach to Measuring Phantom Limb Pain in Amputees

The quantification of phantom limb pain (PLP) is challenging due to the heterogeneity of patient experiences. This study evaluated the use period prevalence questionnaires in assessing PLP in patients with lower limb osseointegrated implant (OI) prostheses.

The study included patients who received single-stage lower limb OI prostheses at our institution. Period prevalence questionnaires included questions regarding frequency and duration of PLP prior to OI implantation and in the last year postoperatively. The frequency of PLP was assessed by asking participants how often they experienced PLP pain. The duration of each episode was evaluated by asking how long the PLP pain lasted. Nerve reconstruction procedures included targeted muscle reinnervation (TMR) or combined TMRpni.

A total of 11 patients completed the questionnaire (7 transtibial and 4 transfemoral). The median age was 52 years, and the median BMI was 29.7 kg/m 2 . Of the 11 patients, 8 underwent nerve reconstruction (72%): 5 with combined TMRpni and 2 with TMR. Six patients reported a reduction of PLP episodes (54%), whereas the remaining 5 patients experienced the same frequency of PLP. Statistical analysis revealed a significant reduction in PLP frequency from preop to postoperative time points (median, 4 vs 3; P  = 0.016). For PLP duration, 5 patients reported shorter episodes (45.5%), 5 patients reported the same duration (45.5%), and 1 patient experienced a longer duration (9%). There was no significant difference in duration between preoperative and postoperative assessments. When examining the total scores, there was a significant reduction of PLP from preoperative to postoperative time points (median, 6 vs 5; P  = 0.048).

We introduced a novel method to assess PLP using period prevalence instead of pain intensity. OI prostheses, with or without nerve reconstruction, significantly reduced PLP frequency and combined frequency-duration measures. Future work will validate the period prevalence survey against established PLP instruments.