Prevalence and risk factors of phantom limb pain and phantom limb sensations in Germany - A nationwide field survey

Data on the incidence and intensity of phantom limb pain (PLP) and phantom limb sensations (PLS) were collected in a nationwide survey. Supported by a manufacturer of artificial limbs and press notices a total of 537 amputees were contacted and interviewed by questionnaire. The questionnaire containing 62 questions was filled in by 537 out of 1,088 amputees. Of the amputees 14.8% were pain free, 74.5% had PLP, 45.2% stump pain (SP) and 35.5% a combination of both. In addition 62.4% of the amputees reported disturbed sleep, of those with PLP it was even higher at 77.3% and 66.8% of patients with PLP woke up several times during the night. The prevailing features of PLP included burning sensation (13.6%), cramp (15.3%), prickling (23.4%), electrification (21%) and tingling (20.4%). Phantom sensations were felt by 73.4% and were described as being mobile (66.8%), of normal temperature (64%), warm (19.5%), cold (16.5%), bare (35.9%), clothed (13.6%), not unpleasant (31.7%), pressed (29.6%), contorted (7.5%) and blown up (5.8%). Of the patients with PLP, 35.7% described the location as mostly ventral, 26.7% as mostly dorsal. Significantly more PLP was found in the presence of PLS than in its absence (p < 0.0001), but unrelated to the type of PLS, to demographic factors, or to the level or side of amputation. Perception of the artificial limb being "a foreign body" was highly significantly more often associated with PLP than with a sensation of "fusing with the body" (p < 0.0001). To our knowledge the present study constitutes the largest field survey on phantom limb pain carried out in Europe and corroborates the high prevalence and intensity of PLP, unusual PLS and amputation-related sleep disturbances. The significance and manageability of phantom feelings and its risk factors need further research.