Veteran Perspectives on Phantom Limb Pain and Non-Drug Interventions

Abstract

Tonya L Rich,1,2 Hannah L Phelan,1,3 Amy A Gravely,1 Kierra J Falbo,1,2 Jacob A Finn,1,4 Mary E Matsumoto,1,5 Katherine J Muschler,1 Christine M Olney,1,2,6 Jessica E Kiecker,1 Andrew H Hansen1,2,7 1Minneapolis Veteran’s Affairs Health Care System, Minneapolis, MN, USA; 2Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA; 3Medical College of Wisconsin, Milwaukee, WI, USA; 4Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA; 5Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA; 6Department of Nursing, University of Minnesota, Minneapolis, MN, USA; 7Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USACorrespondence: Tonya L Rich, Tel [phone], Fax [phone], Email [email protected]: Phantom limb pain (PLP) commonly occurs post-amputation and can negatively affect the daily functioning of persons with amputation. Best practices for medication and non-drug management remain unclear.Objective: To better understand the PLP experience and patients’ familiarity with treatments, phone interviews were conducted at the Minneapolis Veterans Affairs Regional Amputation Center in Veterans with amputations.Methods: Fifty Veteran participants (average age 66, 96% male) with lower limb amputation were recruited for phone-based data collection of patient-reported outcomes (ie, demographics using the Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R) and pain experience using the Phantom Phenomena Questionnaire) to characterize the population and a semi-structured interview. Notes taken during interviews were analyzed using the Krueger and Casey constant comparison analysis method.Results: Participants had an average of 15 years since amputation, and 80% reported PLP as identified with the Phantom Phenomena Questionnaire. Investigators identified several core themes from the qualitative interviews including 1) high variability in the experience of PLP, 2) acceptance and resilience, and 3) PLP treatment perceptions. The majority of participants reported trying common non-drug treatments with none endorsed consistently as highly effective.Conclusion: More research is needed to inform identification and implementation of clinical best practices for non-drug interventions for PLP and understand the factors that influence engagement in non-drug interventions. The participants in this study were largely male, so these results may not be generalizable to females.Keywords: amputation, phantom limb pain, rehabilitation, non-drug interventions, pain

Keywords

• amputation
• phantom limb pain
• rehabilitation
• non-drug interventions
• pain