The prevalence and risk factors for phantom limb pain in people with amputations: a systematic review and meta-analysis

Abstract

Background and objective Phantom limb pain (PLP) is a common complication in people with limb amputations. There are conflicting reports in the literature regarding the prevalence of PLP in people with limb amputations. Therefore, this review aimed to determine the estimated pooled prevalence of PLP, and risk factors associated with this complication. Methods Articles published between 1980 and July 2019 were identified through a systematic search of the following electronic databases: MEDLINE/PubMed, PsycINFO, PsycArticles, Cumulative Index to Nursing and Allied Health Literature, Africa−Wide Information, Health Source: Nursing/Academic Edition, SCOPUS, Web of Science and Academic Search Premier. Grey literature was searched on databases for preprints. Two reviewers independently performed the screening of articles, data extraction and risk of bias assessment. The meta−analyses were conducted using the random−effects model. A statistically significant level for the analyses was set at p>0.05. Results The pooling of all studies demonstrated a prevalence estimate of 63% [95% CI: 58.23−67.05] with high heterogeneity [I2=95.70% (95% CI: 95.10−96.20)]. The prevalence of PLP was significantly lower in developing countries compared to developed countries [53.98% vs 64.55%; p=0.04]. Persistent pre−operative pain, proximal site of amputation, lower limb amputation, stump pain and phantom sensations were identified as risk factors for PLP. Conclusion This systematic review and meta−analysis estimates that six of every 10 people with an amputation report PLP − a high and important prevalence of PLP. Health care professionals ought to be aware of the high rates of PLP and implement strategies to reduce PLP by addressing known risk factors, specifically those identified by the current study.

Prevalence and incidence of phantom limb pain, phantom limb sensations and telescoping in amputees: A systematic rapid review

“…The prevalence estimates reported here are similar to the pooled estimate of 63% in a recent meta-analysis (Limakatso et al, 2019). Our findings suggest that lifetime prevalence is higher than this estimate, but given the wide variation in reported measures of period and point prevalence, the pooled value by Limakatso et al (2019) is likely to provide clinicians and patients with either an underestimate or overestimate of true prevalence for a patient in a given set of circumstances and timeframe. Furthermore, the high statistical heterogeneity (I 2 = 95.7%) reported between the included pooled studies of the previous review highlights that a more nuanced approach to PLP estimates is warranted.…”

“…It is possible that in doing so, other incidence/prevalence data have been omitted which may alter the estimates reported. However, that a recent review (Limakatso et al, 2019) on prevalence with no limitations on search date found similar levels of heterogeneity (I 2 = 95%) suggests that such rate variation is indicative of the field, and extends to current research in this area.…”

“…While the aetiology of PLP is unclear, it is postulated to involve changes within the peripheral and central nervous systems following amputation (Lenggenhager, Arnold, & Giummarra, 2014). Recent work has suggested that features related to the amputation, such as pre-amputation pain, stump pain, sleep disturbances and/or diabetic/traumatic causes of amputation, may be associated with PLP development (Limakatso et al, 2019). However, once present, PLP is difficult to treat, with current pharmacological and non-pharmacological interventions showing only minimal to moderate benefits (Alviar, Hale, & Dungca, 2016).…”

“…There is limited synthesis of the literature investigating the prevalence or incidence of phantom phenomena, with most systematic reviews focussing on PLP treatment (Alviar et al, 2016;Herrador Colmenero et al, 2017;Johnson, Mulvey, & Bagnall, 2015). Very recently, a systematic review evaluated the prevalence of PLP (Limakatso et al, 2019) and while an overall pooled estimate for the prevalence of PLP (63%) was provided, all prevalence measures at all time points were included (i.e. point, period, lifetime).…”

Reassessing face topography in primary somatosensory cortex and remapping following hand loss

“…Thereafter, human measurement of topographic shifts has tended to focus on that of the lips, where researchers have reported that shifted lip representation towards and into the deprived hand area is significantly associated with phantom limb pain (PLP) intensity [18][19][20][21][22] . PLP is a neuropathic pain syndrome experienced in the missing, amputated limb by the majority of amputees 23 . This condition is commonly thought to arise from maladaptive cortical plasticity in S1 (although see 24 ), specifically from a signal mismatch between the missing hand representation and the remapped inputs of the lips in the deprived hand area 25 .…”