Researchers conducted a prospective cohort study to examine the relationship between postamputation pain, psychiatric symptoms, and quality of life (QOL) in military servicemembers. The cohort included 156 Ukrainians with war-related amputations who were treated between June 2023 and September 2024. Phantom limb pain, residual limb pain, anxiety, depression, and QoL were assessed longitudinally at baseline, and again at three, six, and 12 months.
Mixed-effects repeated-measures models tested time effects and time-varying associations of anxiety, depression, and QoL with phantom limb pain and residual limb pain. Cross-lagged panel models tested prospective, directional associations between psychological factors and subsequent pain across follow-up while accounting for pain stability and within-wave correlations.
The researchers found that outcomes improved over time, with mixed-effects models showing a strong time effect for both phantom limb pain and residual limb pain. Higher QoL was associated with lower phantom limb pain and residual limb pain, while higher anxiety and depression were associated with greater residual limb pain.
In cross-lagged models, depressive symptoms and anxiety were associated with higher subsequent phantom limb pain, whereas QoL was associated with lower subsequent phantom limb pain. Phantom limb pain showed no lagged associations with later depression, anxiety, or QoL, the study found, and for residual limb pain, the only directional lagged association was with later depressive symptoms.
The participants’ phantom limb pain and residual limb pain improved substantially over 12 months alongside reduced psychological distress and improved QoL. QoL was linked to both pain outcomes across recovery, while anxiety and depression show stronger and time-varying relationships with residual limb pain than phantom limb pain.
Cross-lagged models indicated that affective/QoL measures were linked to later phantom limb pain, while residual limb pain was linked to later depressive symptoms, supporting distinct coupling mechanisms, the study found.
The open-access study, “The association between quality of life, anxiety and depression, and residual limb and phantom limb pain in war-related amputees: A year-long observational study,” was published in the journal eClinicalMedicine.
