Anxiety and Depression in Patients with Amputated Limbs Suffering from Phantom Pain: A Comparative Study with Non‑Phantom Chronic Pain

Hadi Kazemi, Shahin Ghassemi, Seyed-Mohammad Fereshtehnejad, Afshin Amini, Pier Hossein Kolivand, Taher Doroudi


Background: Phantom limb pain (PLP) is approximately a common condition after limb amputation, which potentially affects the quality of life. We aimed to evaluate anxiety and depression in patients with amputated limbs suffering from PLP and to compare these psychological dysfunctions with that of patients with non‑phantom chronic pain.

Methods: A total number of 16 male amputees with PLP and 24 male age‑matched patients with non‑phantom chronic pain were recruited in this study, which was performed at Khatam‑Al‑Anbia Pain Clinic, Tehran, Iran. A validated Persian version of the hospital anxiety and depression scale (HADS) was used to compare two psychological dysfunctions – anxiety and depression – between the two groups of study.

Results: The mean of total anxiety score was significantly lower in patients with PLP (8.00 ± 3.93 vs. 11.25 ± 5.23; P = 0.041) and the prevalence of anxiety caseness (HADS‑A score ≥ 11) was also lower in the PLP group (25% vs. 58.3%; P = 0.112, power = 31.7%). The mean of total depression score was 7.69 ± 5.51 and 9.38 ± 6.11 in patients of PLP and chronic pain groups, respectively (P = 0.340, power = 15%).

Consequently, the prevalence of depression caseness (HADS‑D score ≥ 11) was lower in PLP patients (37.5% vs. 50%; P = 0.710, power = 8%).

Conclusion: Our results indicate that depression and anxiety are not more common in PLP patients, whereas they are more prevalent in subjects with non‑phantom chronic pain. These lower levels of anxiety and depression in PLP compared with chronic pain is a new finding that needs to be evaluated further, which may lead to new insights into the pathogenesis of phantom pain in further studies.

Keywords: Anxiety, chronic pain, depression, hospital anxiety and depression scale, phantom limb pain

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