Body image and perception among adults with and without phantom limb pain

Abstract
Background: Following lower-limb amputation, phantom limb pain (i.e., pain perceived as coming from the amputated portion of the limb) is common. Phantom limb pain may be associated with impaired body image and perception, which may be targets for rehabilitative intervention. Objective: To compare measures of body image and perception between adults with and without phantom limb pain post amputation and evaluate associations between measures of body image and perception and phantom limb pain. Design: Survey. Setting: Online, remote assessment. Participants: Seventy-two adults ≥1 year post unilateral lower-limb loss (n = 42 with phantom limb pain, n = 30 without phantom limb pain or pain in the remaining portion of the limb). Interventions: Not applicable. Main Outcome Measures: Self-reported outcome measures assessing body image (i.e., Amputee Body Image Scale-Revised), perceptual disturbances associated with the phantom limb (i.e., a modified Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale), and prosthesis satisfaction (i.e., Trinity Amputation and Prosthesis Experience Scale) were administered; participants with phantom limb pain reported pain interference via the Brief Pain Inventory-Short Form. Between-group comparisons of self-reported outcome measure scores were conducted using Mann Whitney U or chi-square tests, as appropriate (a = .05). Results: Compared to peers without phantom limb pain, adults with phantom limb pain reported more negative body image; increased phantom limb ownership, attention, and awareness; and reduced prosthesis satisfaction and embodiment (U = 175.50–364.00, p < .001 to .034). Disturbances in phantom limb perception (i.e., size, weight, pressure, temperature) were similar between groups (p = .086 to >.999). More negative body image was associated with increased phantom limb pain interference (τb = .25, p = .026). Conclusions: Adults with phantom limb pain demonstrate more negative body image and hypervigilance of the phantom limb as compared to peers with nonpainful phantom sensations. Mind-body treatments that target impaired body image and perception may be critical interventions for adults with phantom limb pain.
Description
This is the peer reviewed version of the following article: Beisheim-Ryan, EH, Hicks, GE, Pohlig, RT, Medina, J, Sions, JM. Body image and perception among adults with and without phantom limb pain. PM&R: The Journal of Injury, Function and Rehabilitation. 2022; 1- 13. doi:10.1002/pmrj.12750, which has been published in final form at https://doi.org/10.1002/pmrj.12750. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited. This article will be embargoed until 12/15/2022.
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Citation
Beisheim-Ryan, EH, Hicks, GE, Pohlig, RT, Medina, J, Sions, JM. Body image and perception among adults with and without phantom limb pain. PM&R: The Journal of Injury, Function and Rehabilitation. 2022; 1- 13. doi:10.1002/pmrj.12750