Comparing Real-Time and Recalled Ratings of Phantom Limb Pain Intensity

Evidence-based practice relies on accurate measurement of healthcare conditions. However, measurement of phantom limb pain after amputation can be challenging due to the varying intensity, duration, and quality of pain episodes. Standard measurement of phantom limb pain involves patient recall during clinic appointments and therefore may provide biased information. The purpose of this study was to compare recalled average and maximum ratings of phantom limb pain intensity with real-time ratings.

Participants (n = 17, 59% male, age 32-76) with lower limb amputation completed momentary ratings of phantom limb pain intensity on a 0-10 scale via ecological momentary assessment surveys on their mobile devices three times per day for 40 days. Momentary average and maximum ratings were compared to participants' recalled ratings on a 0-10 scale using standard clinical questions.

Average recalled phantom limb pain intensity ratings were significantly higher than average momentary ratings when including zeros in the momentary average calculation (6.53 vs. 1.99; p < 0.001) and when including only nonzero momentary ratings (6.53 vs. 5.08; p = 0.001). Additionally, maximum recalled phantom limb pain intensity ratings were significantly higher than maximum momentary ratings (9.06 vs. 7.59; p = 0.001).

These results suggest that momentary ratings of phantom limb pain intensity may yield more accurate information than standard recalled ratings. Assessment of phantom limb pain in a clinical setting could benefit from more frequent, real-time measurement to better track changes in pain and evaluate treatment effects.