Phantom limb pain as a predictor of negative dysfunctional emotions in lower-limb amputee patients

Den Heuvel 2011). Loss of a limb is a big stress for the patient, numerous studies certifying this (Horgan & MacLachlan 2004; Solgajová et al 2015). Loss of a limb may cause emotional distress not only from the loss of a body part, but also because of the limitation of activities and roles the amputee can achieve afterwards, being necessary to adapt to the new lifestyle. Loss of a limb favors the occurrence of depressive symptoms in the context of certain risk factors sense of loss, self-stigma, and difficulties in managing the new status (Durmus et al 2015; Mckechnie & John 2014). Another risk factor for depressive symptoms is the presence and intensity of pain in the phantom limb (Darnall et al 2005; Desmond & Maclachlan 2006; Skoufa et al 2015). Unfortunately, dysfunctional negative emotions such as depression and anxiety persists 2-3 years after ablative surgery (Singh et al 2009). Post amputation pain in the phantom limb occurs at a rate of 60% 80% (26), and is defined as a painful sensation felt in the area of amputated limb (Jensen et al 1983; Jensen et al 1985; Manchikanti & Singh 2004; Ribbers et al 1989). The incidence of emotional distress decreases in the following conditions: after a certain period of time since the surgery, in the context of high social support, prosthetic satisfaction, the Introduction Amputation refers to partial or complete loss of an organ or part of the body that occurs as a result of surgery or an accident. The incidence of surgery involving a leg amputation is 11 times higher than that of the upper limb (Stewart et al 1992). Ablative surgery takes place if the limb salvage is impossible (Smith & Skinner 2014; Uustal 2015). After limb amputation, the patient is not only physically and mentally affected, but also the social and family relationships get to be impaired, thus often patients tend to isolate themselves and severely limit their activities. That is why, limb loss may have catastrophic consequences, meaning much more than the loss of a limb, namely the presence of emotional distress (Dadkhah et al 2003). Stress is a physiological or psychological response of the individual and/or the body in a stressful situation (Zlate 2009). On the other hand, emotional distress is defined as a negative emotional reaction, which can include anxiety, depression, fear, anger in response to a stress factor. Loss of a limb is often felt as painful as losing a partner (Parkes 1972), being associated with the loss of wholeness feeling of the body (Kingdon & Pearce 1982) and increased incidence of mortality. All this can lead to severe emotional distress associated with a poor quality of life (Pell et al 1993; Sinha & Van Abstract. Objective: The purpose of this study is to evaluate whether phantom limb pain, body image, activity restriction, psychosocial adjustment and satisfaction with prosthesis helps predict alteration and level of emotional distress among amputee patients. Material and method: The study was an observational, retrospective study. Forty patients, participants aged 63.86±9.63 years; 32 were males (80%) and 8 females (20%), that underwent lower limb amputation during 2014-2017 at the Surgical Clinic II Cluj County Hospital have been evaluated. Measurements were performed using specific questionnaires for assessing the predictor variables (pain in the phantom limb, body image, activities limitation, psychosocial adaptation to the status of amputee and satisfaction with prosthesis) and the outcome variable (dysfunctional negative emotions such as depression and anxiety). Results. Preliminary data show that phantom limb pain and psychosocial adaptation, as independent variables, accounts for 31.6% of variance of the dysfunctional negative emotions and makes a significant contribution to the regression model. On the other hand, body image, activity restriction, or satisfaction with prosthesis were not independently linked to dysfunctional negative emotions. Conclusions. The results show that phantom limb pain and psychosocial adaptation were significant predictor of dysfunctional negative emotions, therefore interventions to reduce or suppress it, have an impact in reducing emotional distress in patients that have undergone lower limb amputation.