title: Concordance of Phantom and Residual Limb Pain Phenotypes in Double Amputees: Evidence for the Contribution of Distinct and Common Individual Factors.
abstract: Most, but not all, limb amputees develop phantom limb pain (PLP) or residual limb pain (RLP), and large interindividual differences in pain intensity and course are apparent. The present cross-sectional study of 122 double amputees investigated the possible role of genetic factors in PLP and RLP, assuming that strong individual predisposition results in high intraindividual concordance in pain phenotype. Intraindividual concordance was observed in 116 (95%) patients for development of PLP and in 110 patients (90%) for development of RLP. For both pain types, high intraindividual concordance was also observed for remission and current intensity. Moderate association for lifetime history and current intensity of PLP and RLP was observed both within and between limbs. The high intraindividual concordance in pain phenotypes suggests strong individual predisposition for PLP and RLP development. However, the finding of only moderate association between PLP and RLP suggests that susceptibility to these pain phenomena involves distinct, as well as common, risk factors. Genome-wide studies in large samples of single amputees may facilitate the dissection of these phenotypes and their underlying mechanisms.
  
  
  CONCLUSIONS
  The observation of high intraindividual concordance for PLP and RLP in 122 double amputees suggests that individual factors contribute to post-amputation pain. The relatively low intraindividual association between PLP and RLP suggests that these factors are at least partially specific for each pain type.
authors.affiliation: Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Psychobiology, University of Trier, Trier, Germany. Electronic address: fabian.streit@zi-mannheim.de.
authors.forename: Fabian
authors.initials: F
authors.lastname: Streit
authors.affiliation: Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Robin
authors.initials: R
authors.lastname: Bekrater-Bodmann
authors.affiliation: Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Psychosomatic Medicine and Psychotherapy, LWL-University, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Diers
authors.affiliation: Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Iris
authors.initials: I
authors.lastname: Reinhard
authors.affiliation: Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Frank
authors.affiliation: Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Experimental Psychology, University of Regensburg, Regensburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wüst
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada; Centre for the Study of Pain, Faculties of Dentistry and Medicine, University of Toronto, Toronto, Canada.
authors.forename: Ze'ev
authors.initials: Z
authors.lastname: Seltzer
authors.affiliation: Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Herta
authors.initials: H
authors.lastname: Flor
authors.affiliation: Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Marcella
authors.initials: M
authors.lastname: Rietschel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects*; D000674:Amputees; D003430:Cross-Sectional Studies; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000235:genetics; D010147:Pain Measurement; D010591:Phantom Limb / Q000235:genetics* / Q000503:physiopathology; D010641:Phenotype; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Phantom limb pain; concordance; heritability of pain; multiple amputations; residual limb pain