Phantom pain: natural history and association with rehabilitation

All 338 lower limb amputees under the care of one disablement services centre were asked to assess phantom pain severity at different times after amputation. Of 212 (63%) replies, 13 had died, 22 were non-limb wearers and 22 were unable to complete the questionnaire. In all, 176 useful replies were received--96 below-knee, 74 above-knee and 6 through-knee. Of these, 98 amputations were performed for trauma and 78 for vascular disease. Below-knee amputees rehabilitated better than above-knee amputees (P < 0.05) and traumatic better than vascular amputees (P < 0.0001). Preoperative pain was worse in vascular amputees (P < 0.0005), but there was no significant difference in the amount of phantom-pain experienced by vascular and traumatic amputees. Phantom sensations were experienced by 82% and phantom pain by 78%. Phantom pain decreased with time, was present equally in traumatic and vascular amputees, and was related to the amount of preoperative pain (P < 0.005). Only 22% felt phantom pain had impaired their rehabilitation. Rehabilitation score was related to phantom pain severity at the time of questionnaire completion (P < 0.05), but not at other specified times after operation.