Introduction: Individuals with upper-limb amputation (ULA) have increased risk for contralateral limb pain (CLP), and further study of CLP in ULA is needed. Study objectives were to: (1) describe CLP frequency, intensity, and 1-year change; (2) identify factors associated with CLP; and (3) quantify associations between CLP, health-related quality of life (HRQoL), and disability (QuickDASH). Methods: A total of 776 veterans with unilateral ULA were surveyed at baseline, and 562 were surveyed again at 1 year. Participants reported CLP frequency and intensity and nonamputated limb conditions. Multivariable models examined factors associated with CLP, as well as associations between CLP intensity and HRQOL (physical component score and mental component score) and disability (QuickDASH).
Results: Contralateral limb pain prevalence was 72.7% (baseline) and 71.6% (follow-up); 59.8% had persistent pain. Contralateral limb conditions and neck and residual limb pain were associated with higher odds of CLP. Black race (vs White), back pain (vs without), and age 45 to 65 years (vs 18–45 years) were associated with greater CLP intensity. Female sex (vs male) and use of cosmetic prostheses (vs body-powered) were associated with lower intensity. The mental component scores were 2.7 and 6.6 points lower for moderate and severe CLP, respectively; the physical component scores were 4.2 and 8.4 points lower for moderate and severe CLP; and QuickDASH scores were 9.4 and 20.7 point higher for moderate and severe CLP, compared with none to mild pain.
Conclusions: Findings suggest that overreliance on the nonamputated limb, leading to CLP, occurs regardless of amputation level or prosthesis use. Further research is needed to understand whether disparities in pain treatment exist by race. Contralateral limb pain is prevalent and persistent in veterans with ULA. Moderate to severe CLP is associated with worse HRQOL and greater disability. Efforts are needed to prevent and treat ULA CLP pain.
Clinical Relevance: Clinicians caring for persons with unilateral ULA should evaluate the contralateral upper limb and refer patients to appropriate therapies to address painful conditions. Persons with ULA should be educated about the risks of development of CLP and be provided with strategies to minimize overuse when possible. (J Prosthet Orthot. 2023;35:3–11)
Individuals with upper-limb amputation (ULA) are at increased risk for contralateral limb pain (CLP) as compared with the general population, in part because of overreliance on the sound limb and increased susceptibility to overuse injuries. Veterans with ULA are at even higher risk. Approximately 80% of adults with ULAs in the United States, the United Kingdom, and Canada use a prosthesis. In comparison, only 60% of the overall population of US veterans with unilateral ULA use a prosthesis.
Those with unilateral amputation depend on their sound limb for daily activities, regardless of whether they use a prosthesis. Upper-limb prosthetic devices can be inefficient and uncomfortable and do not fully restore function, contributing to altered body mechanics and compensatory movements for those who do use them.
An estimated 36% to 57% of persons with ULA report CLP. In a nationally representative study of US adults, prevalence estimates of CLP were the following: 19.9% for the shoulder, 16.8% for the hand, 9.8% for the wrist, and 1.2% for the arm. Chronic pain of the upper limb was reported in 4.1% in a US population with ULA. Furthermore, almost one third of persons with ULA in the Washington state area of the United States reported CLP lasting at least 3 months. The rates of CLP in US veterans with ULA exceed rates previously reported, with 71% experiencing CLP. The persistence of CLP in veterans has not been previously examined.