Phantom pain, anxiety, depression, and their relation in consecutive patients with amputated limbs: case reports

Parkes suggested that emotional factors are influential in patients' experience of prolonged pain in a phantom limb after amputation and concluded that this may be prevented if patients are encouraged to express grief over their loss. 1 However, Katz and Melzack found no significant difference in standardised tests of psychological dysfunction between patients who experienced phantom pain and those who did not. They concluded that the pain is more likely to vary with the experience of preamputation pain, even retaining many of its characteristics. 2 A review of the literature on measures used to diagnose psychopathology found that many measures include items that confound emotional distress with the physical disorder and thus overestimate it. 3 We investigated whether people who had had arms or legs amputated experienced emotional distress, and the relation between the distress and pain, using standardised screening techniques designed for patients with physical illness.

Patients, methods, and results

Calculations of sample size indicated that 21 patients per group would be needed to show a reliable difference at the 5% level of significance. The participants were 93 consecutive...