Phantom limb telescoping in individuals with limb loss: links to anxiety, depression, and pain-related measures

Phantom limb pain (PLP) and residual limb pain (RLP) have been widely studied following limb loss; however, the role of telescoping, the perceived shortening of the phantom limb, remains poorly understood in pain and psychosocial outcomes. Using a cross-sectional observational design, this study examined whether PLP and RLP intensity, pain interference, and psychosocial functioning differ between individuals who report telescoping and those who do not. Fifty-one adults with limb loss (mean age = 49.5 years, SD = 15.4) completed measures of PLP and RLP intensity (0-10 numeric rating scale), telescoping (presence and percent), pain interference (Brief Pain Inventory-Short Form), pain catastrophizing (Pain Catastrophizing Scale-4), neuropathic pain (ID Pain Questionnaire), pain acceptance (Chronic Pain Acceptance Questionnaire-8), anxiety and depression symptoms (Patient Health Questionnaire-4), optimism (Life Orientation Test-Revised), and resilience (Connor-Davidson Resilience Scale-2). Twenty-three participants (45.1%) reported telescoping, while 28 (54.9%) did not. Telescoping was more common among younger participants and those with upper-limb loss, particularly right-sided below-elbow loss (all ps < .05). No significant between-group differences were observed for PLP intensity, RLP intensity, or pain interference (all ps > .05). However, greater percent telescoping was associated with lower pain interference (r = -.43, p = .040) and lower PLP intensity (r = -.49, p = .018). Participants reporting telescoping also endorsed higher symptoms of anxiety (p = .022) and depression (p = .029) relative to those with normal length phantoms. These findings suggest that telescoping may reflect distress linked to symptom monitoring and potentially adaptive cortical reorganization associated with reduced PLP.