Psychological Causes for Phantom Limb Pain

Brain Illustration.  

There are several theories behind the origin of phantom limb pain. In this article, we will look at the psychological factors affecting PLP.

The Evolution of Explanation for Phantom Limb Pain From Narcissistic Personality to Neurology

The study of the effects of emotional disturbances on phantom limb pain began to emerge in the mid-20th century and was divided into two rival theories. While some studies presented that there is no significant correlation between phantom limb syndrome and psychological factors [1] [2], contrarily, others argued that PLP reflects amputees’ narcissistic desire and denial of limb loss [3]. Researchers who support this argument believe that permanent disability due to amputation causes patients to experience loss and self-stigma, and the melancholy can then be translated into PLP.

Later research has shown that both amputees with PTSD and major depression and mentally healthy amputees can develop chronic pain in phantom limb. However,The occurrence and severity of phantom pain do not seem to be related to general psychiatric symptoms [4] [5]. In addition, the results of recent PLP studies focusing on neuroplastic effects in amputees indicate that the cause of PLP is triggered by neurological disorders.

The Correlation Between Negative Affectivity and Phantom Limb Pain

Dr. Richard A. Sherman’s research (1989) lays the foundation for the contemporary theory of the interaction between psychological factors and PLP. His study of the amputee experience of stress shows that 37% of the research subjects underwent more intense PLP after a stressful event, yet 44% of them displayed a remarkable increase in stress levels due to phantom limb syndrome [6]. In other words, stress and PLP appear to correlate closely and have bidirectional relationships, which is in line with later studies of the vicious cycle formed by phantom limb syndrome and negative emotive factors such as depression, stress, anxiety, fatigue, and insomnia. It is worth noting that, recent research has shown high prothesis satisfaction can significantly improve amputees’ mental state [7] [8] [9].

The study of psychological contribution to PLP is still insufficient. The subject about the influence of emotion on PLP remains controversial, but by making a comprehensive review of existing research, we can presume that psychological variables do not seem to cause PLP, but they are likely to affect the severity and perception of pain experience, thus the influence of emotive factors on PLP cannot be underestimated.

In a unique time like this, emotional impact caused by social distance and isolation may exacerbate the symptoms of PLP, so knowing how to deal with fear and stress is essential in these days.

REFERENCES

[1] Fisher K, & Hanspal RS. (1998). Phantom pain, anxiety, depression, and their relation in consecutive patients with amputated limbs: case reports. British Medical Journal, 316(7135), 903–90

[2] Katz, J. (1992). Psychological contributions to phantom limbs. Canadian Journal of Psychiatry, 37, 282-29

[3] Dejours C (2001). Le corps d’abord: Corps biologique, corps érotique et sens moral. Paris.

[4] Mall C, Trivedi J, Mishra U, Sharma V, Dalal P, Katiyar M, Srivastava S, and Sinha P (1997) Psychiatric sequelae of amputation: I immediate effects. Indian Journal of Psychiatry. 39(4):313-7.

[5] Durmus D, Safaz I, Adıgüzel E, Şan A, Sarısoy G, Goktepe A, and Tan A (2014) The relationship between prosthesis use, phantom pain and psychiatric symptoms in male traumatic limb amputees. Comprehensive Psychiatry. 59.

[6] Sherman R. A. (1989). Stump and phantom limb pain. Neurologic Clinic, 7 (2), 249-64

[7] Overton P, Simpson J, Burden N, Powell P, Murray C (2018) Prosthesis use is associated with reduced physical self-disgust in limb amputees. Body Image. 27.

[8] Ali Z, Khurshid L, Bhat T, Bhat A, Vakil S (2018) Prevalence of psychiatric illnesses after major limb amputation and early recognition and treatment in economically lower income group patients. International Journal of Research in Orthopaedics, Vol 4, No 6 (2018).

[9] Piazza L, Ferreira E, Minsky R, Pires G, and Silva R (2019) Psychosocial and physical adjustments and prosthesis satisfaction in amputees: a systematic review of observational studies. Disability and Rehabilitation Assistive Technology. DOI: 10.1080/17483107.2019.1602853.