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

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 p s < .05). No significant between-group differences were observed for PLP intensity, RLP intensity, or pain interference (all p s > .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.