An Evaluation of Phantom Pain among Traumatic Lower Limb Amputees in Lahore

Main Article Content

Maha Aslam
Samreen Sadiq
Izzat Hassan Rana
Bakhtawar Lashari
Dilawaiz Raza
Maheen Rehman


Background: Amputation is the surgical removal of all or part of an irreparably damaged limb due to injury or disease. Trauma is the leading cause of lower limb amputation in Pakistan. Phantom limb pain (PLP) is a common and distressing complication following amputation, affecting the quality of life and functional outcomes.

Objective: The primary objective of this study was to assess the occurrence and intensity of phantom limb pain in patients who had undergone lower limb amputation due to traumatic causes in Pakistan.

Methods: A descriptive cross-sectional study was conducted over six months, involving 73 patients who had undergone lower limb amputation due to trauma. The study was carried out in Ghurki Trust Teaching Hospital, Sheikh Zayed Hospital, and Mayo Hospital. Patients aged 20-45 years, with amputations performed within one year, were included. Exclusion criteria were non-traumatic amputations and amputations older than one year. Non-probability convenience sampling was used. Participants were divided into three groups based on the level of amputation: hip disarticulation (n=12), transfemoral (n=28), and transtibial (n=33). Phantom limb pain was assessed using the Numeric Pain Rating Scale (NRPS), an 11-item scale ranging from 0 (no pain) to 10 (severe pain). Data were analyzed using SPSS version 25, and descriptive statistics were presented in tables and graphs. Ethical approval was obtained from the Ethics Committee of Lahore College of Physical Therapy (ERC-LCPT/298/2019). Written informed consent was obtained from all participants.

Results: The study found that 83.6% of the participants experienced phantom limb pain. Among the hip disarticulation group, 91.7% reported PLP, with a mean NRPS score of 7.3. In the transfemoral group, 89.3% experienced PLP, with a mean NRPS score of 6.8. In the transtibial group, 75.8% reported PLP, with a mean NRPS score of 5.4. The association between the level of amputation and the presence of PLP was significant, with p-values of 0.003 for hip disarticulation, 0.000 for transfemoral, and 0.001 for transtibial amputations.

Conclusion: Phantom limb pain is a prevalent and significant issue among patients with traumatic lower limb amputations in Pakistan, with varying intensity across different levels of amputation. These findings underscore the need for targeted pain management strategies and comprehensive rehabilitation programs to address PLP and improve the quality of life for amputees.

Article Details

How to Cite
Aslam, M., Sadiq, S., Hassan Rana, I., Lashari, B., Raza, D., & Rehman, M. (2024). An Evaluation of Phantom Pain among Traumatic Lower Limb Amputees in Lahore. Journal of Health and Rehabilitation Research, 4(2), 1019–1023.
Author Biographies

Maha Aslam, Integrated Medical Care Hospital Lahore Pakistan.

Physical Therapist, Integrated Medical Care Hospital Lahore, Pakistan.

Samreen Sadiq, Lahore University of Biological & Applied Sciences Lahore Pakistan.

Associate Professor, Department of Physical Therapy and Rehabilitation Sciences, Lahore University of Biological & Applied Sciences Lahore, Pakistan.

Izzat Hassan Rana, Ghurki Trust & Teaching Hospital Lahore Pakistan.

Physical Therapist, Department of Physical Therapy, Ghurki Trust & Teaching Hospital Lahore, Pakistan.

Bakhtawar Lashari, Integrated Medical Care Hospital Lahore Pakistan.

Physical Therapist, Integrated Medical Care Hospital Lahore, Pakistan.

Dilawaiz Raza, Integrated Medical Care Hospital Lahore Pakistan.

Physical Therapist, Integrated Medical Care Hospital Lahore, Pakistan.

Maheen Rehman, Integrated Medical Care Hospital Lahore Pakistan.

Physical Therapist, Integrated Medical Care Hospital Lahore, Pakistan.


Michael JW, Bowker JH. Atlas of Amputations and Limb Deficiencies: Surgical, Prosthetic, and Rehabilitation Principles. American Academy of Orthopaedic Surgeons Rosemont, IL; 2004.

Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050. Arch Phys Med Rehabil. 2008;89(3):422-9.

Rathore FA, Ayaz SB, Mansoor SN, Qureshi AR, Fahim M. Demographics of Lower Limb Amputations in the Pakistan Military: A Single Center, Three-Year Prospective Survey. Cureus. 2016;8(4).

Raffensperger JG. Children's Surgery: A Worldwide History. McFarland; 2014.

Molina CS, Faulk J. Lower Extremity Amputation. 2019.

Kılıç B, Yücel AS, Yaman Ç, Hergüner G, Korkmaz M. Methods of Determining the Amputation Level of Lower Extremity. 2014.

Berardi RS, Keonin Y. Amputations in Peripheral Vascular Occlusive Disease. Am J Surg. 1978;135(2):231-4.

Ajibade A, Akinniyi O, Okoye C. Indications and Complications of Major Limb Amputations in Kano, Nigeria. Ghana Med J. 2013;47(4):185.

Weeks SR, Anderson-Barnes VC, Tsao JW. Phantom Limb Pain: Theories and Therapies. Neurologist. 2010;16(5):277-86.

Raffaeli W, Arnaudo E. Pain as a Disease: An Overview. J Pain Res. 2017;10:2003.

Subedi B, Grossberg GT. Phantom Limb Pain: Mechanisms and Treatment Approaches. Pain Res Treat. 2011;2011.

Journet D. Phantom Limbs and "Body-Ego": S. Weir Mitchell's "George Dedlow". Mosaic. 1990;23(1):87.

Dijkstra PU, Geertzen JH, Stewart R, van der Schans CP. Phantom Pain and Risk Factors: A Multivariate Analysis. J Pain Symptom Manage. 2002;24(6):578-85.

MacIver K, Lloyd D, Kelly S, Roberts N, Nurmikko T. Phantom Limb Pain, Cortical Reorganization and the Therapeutic Effect of Mental Imagery. Brain. 2008;131(8):2181-91.

Richardson C, Glenn S, Nurmikko T, Horgan M. Incidence of Phantom Phenomena Including Phantom Limb Pain 6 Months After Major Lower Limb Amputation in Patients With Peripheral Vascular Disease. Clin J Pain. 2006;22(4):353-8.

Sherman RA, Ernst JL, Barja RH, Bruno GM. Phantom Pain: A Lesson in the Necessity for Careful Clinical Research on Chronic Pain Problems. J Rehabil Res Dev. 1988;25.

Privitera R, Birch R, Sinisi M, Mihaylov IR, Leech R, Anand P. Capsaicin 8% Patch Treatment for Amputation Stump and Phantom Limb Pain: A Clinical and Functional MRI Study. J Pain Res. 2017;10:1623.

Kelle B, Kozanoğlu E, Biçer ÖS, Tan I. Association Between Phantom Limb Complex and the Level of Amputation in Lower Limb Amputee. Acta Orthop Traumatol Turc. 2017;51(2):142-5.

Hill A. Phantom Limb Pain: A Review of the Literature on Attributes and Potential Mechanisms. J Pain Symptom Manage. 1999;17(2):125-42.

Ephraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin LE. Phantom Pain, Residual Limb Pain, and Back Pain in Amputees: Results of a National Survey. Arch Phys Med Rehabil. 2005;86(10):1910-9.

Limakatso K, Bedwell GJ, Madden VJ, Parker R. The Prevalence and Risk Factors for Phantom Limb Pain in People With Amputations: A Systematic Review and Meta-Analysis. PLoS One. 2020;15(10).

Vase L, Nikolajsen L, Christensen B, Egsgaard LL, Arendt-Nielsen L, Svensson P, et al. Cognitive-Emotional Sensitization Contributes to Wind-Up-Like Pain in Phantom Limb Pain Patients. Pain. 2011;152(1):157-62.

Hirsh AT, Dillworth TM, Ehde DM, Jensen MP. Sex Differences in Pain and Psychological Functioning in Persons With Limb Loss. J Pain. 2010;11(1):79-86.

Hanley MA, Jensen MP, Smith DG, Ehde DM, Edwards WT, Robinson LR. Preamputation Pain and Acute Pain Predict Chronic Pain After Lower Extremity Amputation. J Pain. 2007;8(2):102-9.

Derbyshire SW, Nichols TE, Firestone L, Townsend DW, Jones AK. Gender Differences in Patterns of Cerebral Activation During Equal Experience of Painful Laser Stimulation. J Pain. 2002;3(5):401-11.

Datta R, Dhar M. Mirror Therapy: An Adjunct to Conventional Pharmacotherapy in Phantom Limb Pain. J Anaesthesiol Clin Pharmacol. 2015;31(4):575.

Foell J, Bekrater-Bodmann R, Diers M, Flor H. Mirror Therapy for Phantom Limb Pain: Brain Changes and the Role of Body Representation. Eur J Pain. 2014;18(5):729-39.

Murray CD, Pettifer S, Howard T, Patchick EL, Caillette F, Kulkarni J, et al. The Treatment of Phantom Limb Pain Using Immersive Virtual Reality: Three Case Studies. Disabil Rehabil. 2007;29(18):1465-9.

Johnson MI, Mulvey MR, Bagnall AM. Transcutaneous Electrical Nerve Stimulation (TENS) for Phantom Pain and Stump Pain Following Amputation in Adults. Cochrane Database Syst Rev. 2015;(8).

Lie JD. Phantom Limb Pain: Current and Emerging Treatments. US Pharm. 2013;3:20.

Most read articles by the same author(s)