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Phantom limb pain and pain interference in lower extremity amputees: The moderating effects of age

Ivan R. Molton, PhD1, Mark P. Jensen, PhD1, Dawn Ehde, PhD2, and Douglas G. Smith, MD3. (1) Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, (2) Rehabilitation Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98124, (3) Department of Orthopaedics & Sports Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98124

Pain is common in persons over 60. Although prevalence rates vary by population, as many as 70% of independently living older adults report chronic pain problems. Pain in older adults is also associated with a range of deficits in quality-of-life, including sleep disturbance, decreased social function and disability. However, there is also some evidence that the association between pain intensity and functioning may diminish with age, such that older adults report lower levels of disability despite similar pain levels. In the present study, we first attempted to determine whether the relationship between pain and pain interference in persons with amputation was moderated by age, consistent with earlier research. We then attempted to evaluate the utility of two models used to account for this moderation (i.e., a developmental coping model and a cognitive-attitudinal model) by comparing the unique incremental variance associated with (1) time since amputation versus (2) chronological age. Participants were 375 lower extremity amputees reporting phantom-limb pain who were recruited from Seattle area hospital databases in compliance with HIPAA and the UW IRB. Participants were primarily Caucasian (81%) men (67%). Measures included the Brief Pain Inventory (BPI) and a 0-10 Numerical Rating Scale measure of average phantom-limb pain intensity over 3 months. Moderated regression analyses indicated that the pain/interference relationship is moderated by age, with pain predicting interference only in younger adults (B = .44, p < .001). Follow-up analyses suggested that time since amputation was a stronger predictor of this relationship than was chronological age, consistent with a developmental-coping model of adjustment in older amputees. Further work should examine these relationships longitudinally in varied pain populations. If replicated, these findings suggest that it is experience with phantom limb pain and the development of effective coping methods over time that account for diminished pain impact in older persons.