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Concordance of Phantom and Residual Limb Pain Phenotypes in Double Amputees: Evidence for the Contribution of Distinct and Common Individual Factors

  • Fabian Streit
    Correspondence
    Address reprint requests to Fabian Streit, MSc, Central Institute of Mental Health, Square J5, D- 68159 Mannheim, Germany.
    Affiliations
    Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

    Institute of Psychobiology, University of Trier, Trier, Germany
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  • Robin Bekrater-Bodmann
    Affiliations
    Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Martin Diers
    Affiliations
    Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

    Department of Psychosomatic Medicine and Psychotherapy, LWL-University, Ruhr-University Bochum, Bochum, Germany
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  • Iris Reinhard
    Affiliations
    Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Josef Frank
    Affiliations
    Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Stefan Wüst
    Affiliations
    Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

    Institute of Experimental Psychology, University of Regensburg, Regensburg, Germany
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  • Ze'ev Seltzer
    Affiliations
    Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada

    Centre for the Study of Pain, Faculties of Dentistry and Medicine, University of Toronto, Toronto, Canada
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  • Herta Flor
    Affiliations
    Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Marcella Rietschel
    Affiliations
    Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Published:September 29, 2015DOI:https://doi.org/10.1016/j.jpain.2015.08.013

      Highlights

      • Phantom and residual limb pain were assessed in 122 double limb amputees.
      • High intraindividual concordance between limbs was observed for each type of pain.
      • Phantom and residual pain were only moderately associated.
      • Intraindividual concordance suggested a predisposition for both types of pain.
      • Medium association between both types of pain suggested some distinct risk factors.

      Abstract

      Most, but not all, limb amputees develop phantom limb pain (PLP) or residual limb pain (RLP), and large interindividual differences in pain intensity and course are apparent. The present cross-sectional study of 122 double amputees investigated the possible role of genetic factors in PLP and RLP, assuming that strong individual predisposition results in high intraindividual concordance in pain phenotype. Intraindividual concordance was observed in 116 (95%) patients for development of PLP and in 110 patients (90%) for development of RLP. For both pain types, high intraindividual concordance was also observed for remission and current intensity. Moderate association for lifetime history and current intensity of PLP and RLP was observed both within and between limbs. The high intraindividual concordance in pain phenotypes suggests strong individual predisposition for PLP and RLP development. However, the finding of only moderate association between PLP and RLP suggests that susceptibility to these pain phenomena involves distinct, as well as common, risk factors. Genome-wide studies in large samples of single amputees may facilitate the dissection of these phenotypes and their underlying mechanisms.

      Perspective

      The observation of high intraindividual concordance for PLP and RLP in 122 double amputees suggests that individual factors contribute to post-amputation pain. The relatively low intraindividual association between PLP and RLP suggests that these factors are at least partially specific for each pain type.

      Key words

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