157: A Study to Determine The Incidence of Phantom Limb Pain After Limb Amputation In Sri Lanka.

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Neuropathic pain , Pain in Special Populations

Background and Aims: Painful or non-painful abnormal unpleasant sensation of an absent limb following amputation is explained as a phantom complex. Pain after amputation could be of two types: Phantom limb pain. (PLP) or residual pain (stump pain). The latter is common in the postoperative period and tends to resolve. Both conditions can coexist as well. Recent studies on PLP in the literature have reported rates as high as 80%. There were no reported studies conducted in Sri Lanka, and the incidence is not available. This is probably due to a lack of presentation for medical attention, a lack of awareness of the disease among patients and medical practitioners, a paucity of specialised treatment modalities, and misdiagnosis.
This study aims to determine the incidence and factors influencing the presentation, severity and medical attention in PLP in Sri Lanka.

Methods: The study was designed as a community-based retrospective study involving former military and civilian amputees who had undergone amputation due to trauma or a planned surgical amputation for non-communicable diseases.
Above 20 years of age, amputation of lower or upper limb and those who have experienced the pain for more than three months were included. The mentally incompetent, terminally ill, or subjects who declined participation were excluded. Socioeconomic, cultural, demographic, and traumatic event details, symptoms of phantom complex, severity and time course, whether they had sought medical attention, and the reasons for the absence of presentation were inquired.
Phantom complex was described as four components under the headings of presence of phantom limb without pain, or with pain, abnormal sensation of the amputated part described as itching, tingling, insect crawling and lightning sensation, residual or stump pain
The Fisher's exact test was used for significance testing.

Results: The sample comprised 64 civilians and 36 military personnel, of whom 86% were males and 56% were between the ages of 36-50 .
80% has experienced phantom complex at varying frequencies; the most common was abnormal sensation.
The most common amputation among both groups was below-knee amputation (67%), and most had experienced phantom limb complex. The above-knee amputation is mostly seen among civilians. But the association was not statistically significant. (p = 0.429 )
The phantom complex is mostly explained in complete traumatic amputations, which were statistically significant. (p = 0.019 )
13 subjects have had post-operative complications, and all suffered phantom complex; of them, 9 had phantom pain.
Phantom pain was found to be statistically significant in 77% military amputees who had undergone rehabilitation (p= 0.037)
Of the 80 amputees with the phantom complex, 76.9% had inadequate income, and only 28.2% received government or non-government benefits. 87.5% had not seek any kind of medical treatment.

Conclusions: There was no significant difference in the prevalence of phantom complex among civilians and military personnel, and no significant association with the amputated part.
The very high prevalence of phantom complex or its components clearly showed that this condition was very much underdiagnosed.
Another significant finding was 87.5% phantom complex sufferers had never sought any treatment. This highlights the fact that most amputees may not have recognised their condition as treatable, or they were not aware of different treatment modalities, including the availability of dedicated clinics to follow with the medical and surgical treatments, including sympathectomies, available in Sri Lanka. Also indicated a probable lack of awareness among the general public.
This problem is affecting a relatively younger population, probably the family's breadwinners, compromising acceptance of the amputation.
More social and medical awareness is needed to diagnose and direct potential candidates to treatment.

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Presenting Author: Vasanthi pinto
Submitting Author: Vasanthi Pinto

Senior Author: Vasanthi Pinto

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Vasanthi pinto: MD, FRCA - University of Peradeniya , Sri Lanka
• K.B.Galketiya: MS,FRCS - University of Peradeniya , SriLanka
• Ranjith Kumarasiri: PHD - University of Peradeniya
• A.H.M.A.H.Abayasinghe: MBBS,MS - University of Peradeniya
• Amalka Premadasa: MBBS,MD - University of Peradeniya