Understanding Phantom Limb Telescoping: A Multimethod Examination of Phenomenology, Pain Relationships, and Psychosocial Context

Abstract

Objective: The aim of this dissertation was to examine phantom limb telescoping in individuals with limb loss and explore its relationship to key pain and mental health-related outcomes.

Method: Study 1 presents a narrative review with a systematic search of the existing literature on phantom limb telescoping. Study 2 is a case report of an individual recruited from St. John’s Rehab in Toronto who completed online questionnaires and an optional interview as part of a larger study. Studies 3 and 4 draw on this broader participant pool, examining quantitative data from questionnaire responses (N = 51) and qualitative data from semi-structured interviews from a subset of the larger sample (N = 12), respectively. Quantitative measures included ratings of phantom and residual limb pain intensity, telescoping, pain interference, pain catastrophizing, neuropathic pain, pain acceptance, anxiety and depression, optimism, and resilience. Interviews explored participants’ perceptions, interpretations, and adaptations related to their phantom limb and telescoping experiences.

Results: Study 1, the narrative review, synthesized findings from 100 studies that investigated or reported phantom limb telescoping. It identified key themes, patterns, limitations, and gaps, as well as potential avenues for future study to better understand the mechanisms of telescoping and its relationship to post-amputation pain, among other factors. In Study 2, the case report suggested that the onset of telescoping was preceded by a reduction in phantom limb pain intensity, raising the possibility that telescoping may be associated with lower pain levels compared to a normally perceived phantom limb length. Study 3 revealed significant differences between participants who reported telescoping and those who did were not found for phantom limb pain intensity, residual limb pain intensity, or pain interference. However, greater telescoping was associated with lower pain interference and lower phantom limb pain intensity. Participants who reported telescoping also endorsed higher symptoms of anxiety and depression compared to those who reported a normal length phantom limb. In Study 4, telescoping was experienced as a dynamic and individualized process shaped by emotional, social, and contextual influences, extending beyond sensory changes to encompass meaning-making, adaptation, and identity.

Discussion: Across four studies, this dissertation provides a more integrated understanding of phantom limb telescoping as a sensory, psychological, and contextual experience. The narrative review (Study 1) highlighted persistent gaps in knowledge and inconsistent findings regarding mechanisms and pain. The case report (Study 2) and quantitative results (Study 3) suggested that greater telescoping may be associated with lower phantom limb pain intensity and reduced pain interference, while also co-occurring with higher anxiety and depression symptoms. The qualitative findings (Study 4) underscored that telescoping is experienced in highly individualized ways, shaped by emotional factors, personal meaning, and ongoing adaptation. Collectively, these studies demonstrate that telescoping cannot be understood solely as a perceptual change; instead, it reflects an interaction between bodily sensation and psychological processes. Clinically, normalizing discussions about telescoping may help reduce uncertainty for individuals with limb loss and support more holistic rehabilitation care.