# Phantom limb telescoping in individuals with limb loss: links to anxiety, depression, and pain-related measures

## TL;DR

This study explores how phantom limb telescoping relates to pain and mental health in people who have lost a limb.

## Contribution

The study identifies novel associations between phantom limb telescoping and lower pain interference and intensity, alongside higher anxiety and depression symptoms.

## Key findings

- Telescoping was more common in younger individuals and those with upper-limb loss.
- Greater telescoping was linked to lower phantom limb pain intensity and pain interference.
- Telescoping was associated with higher anxiety and depression symptoms.

## Abstract

Phantom limb pain (PLP) and residual limb pain (RLP) have been widely studied following limb loss; however, the role of telescoping, the perceived shortening of the phantom limb, remains poorly understood in pain and psychosocial outcomes. Using a cross-sectional observational design, this study examined whether PLP and RLP intensity, pain interference, and psychosocial functioning differ between individuals who report telescoping and those who do not. Fifty-one adults with limb loss (mean age = 49.5 years, SD = 15.4) completed measures of PLP and RLP intensity (0–10 numeric rating scale), telescoping (presence and percent), pain interference (Brief Pain Inventory–Short Form), pain catastrophizing (Pain Catastrophizing Scale–4), neuropathic pain (ID Pain Questionnaire), pain acceptance (Chronic Pain Acceptance Questionnaire–8), anxiety and depression symptoms (Patient Health Questionnaire–4), optimism (Life Orientation Test–Revised), and resilience (Connor–Davidson Resilience Scale–2). Twenty-three participants (45.1%) reported telescoping, while 28 (54.9%) did not. Telescoping was more common among younger participants and those with upper-limb loss, particularly right-sided below-elbow loss (all ps < .05). No significant between-group differences were observed for PLP intensity, RLP intensity, or pain interference (all ps > .05). However, greater percent telescoping was associated with lower pain interference (r = –.43, p = .040) and lower PLP intensity (r = –.49, p = .018). Participants reporting telescoping also endorsed higher symptoms of anxiety (p = .022) and depression (p = .029) relative to those with normal length phantoms. These findings suggest that telescoping may reflect distress linked to symptom monitoring and potentially adaptive cortical reorganization associated with reduced PLP.