RICHMOND, VA – Phantom limb pain persists for veterans who undergo major upper limb amputation, according to a new study.

The report in the PM&R journal describes the frequency and severity of phantom limb pain (PLP) in veterans with major upper limb amputation, seeking to determine the association between PLP and patient, amputation and prosthesis characteristics.1

The cross-sectional design national survey was of 776 veterans living in the community; most, 97%, were male with a mean age of 63 and a mean time since amputation of 31 years. All of them had the removal of any part of the forearm or arm, with transradial amputation being most common at 36%, and 62% of them reporting accident as the amputation etiology.

Researchers from the Hunter Homes McGuire VAMC in Richmond and the Providence, RI, VAMC joined with colleagues from Virginia Commonwealth University in Richmond and Brown University in Providence to conduct the study. Their focus was on frequency and intensity of phantom limb pain, characteristics such as age and gender, amputation characteristics—including level and etiology—and prosthesis characteristics such as type and intensity of prosthesis.

Results indicate that 73% of amputees reported PLP with a mean intensity score of 4.2 (SD 3.4). In fact, 42% of amputees reported PLP frequency in the daily to always category. The researchers defined weekly and more frequent residual limb pain as having any PLP.

The study indicates that amputation at the shoulder [OR 3.78 (1.93, 7.39)], amputation at the transhumeral level [OR 1.76 (1.10,2.81)], and amputation due to cancer [OR 5.33 (1.15, 24.81)] were also associated with any PLP. Moderate (β = 1.34, p = <0.0001) and severe (β = 3.31, P < 0.0001) residual limb pain intensity was associated with higher PLP intensity among those with pain.

The authors point out that amputation at the shoulder level was associated with a 1.5 points higher average pain intensity score (P = 0.0001) compared to the transradial level. On the other hand, multivariable models failed to show an association between PLP prevalence and amputation of the dominant limb (P = 0.08) and PLP was not associated with intensity of daily prosthesis use in bivariate analyses, the study notes.

“This study of a large cohort of veterans with major upper limb amputation highlights the long-term persistence of moderate frequency and intensity PLP.”


  1. Balakhanlou E, Webster J, Borgia M, Resnik L. Frequency and Severity of Phantom Limb Pain in Veterans with Major Upper Limb Amputation: Results of a National Survey [published online ahead of print, 2020 Sep 8]. PM R. 2020;10.1002/pmrj.12485. doi:10.1002/pmrj.12485