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Losing a limb through amputation is a major life-threatening and life changing experience, whether it occurs during service as a soldier, accidental injury or from disease. Most people who have had an amputation will experience pain afterwards, including an experience of pain apparently in the part of the limb that is no longer there. That is, pain in a phantom limb.

In our recent studies, we investigated the tendency to experience pain when witnessing others in pain—i.e., vicarious pain—in two amputee cohorts. Given the high levels of co-morbidity and likely common neurobiological mechanisms of pain and post-traumatic stress disorder, we specifically investigated the role of PTSD symptoms in the experience of vicarious pain.

Between 10-22% of amputees report experiencing vicarious pain, which was associated with PTSD symptom reporting. However, this was typical only in a sub-group of amputees who also had more intense and disabling chronic pain.

These findings suggest that shared maladaptive neurobiological and/or psychological mechanisms are involved in the experience of vicarious reactivity to the pain of others for some amputees, and that these persons may have a poorer prognosis. The relationship between physical and emotional functioning following amputation is clearly of substantial influence in recovery. As noted, our findings suggest the more severe the chronic pain, the more likely the person was to have PTSD symptoms and vicarious reactivity. It is anticipated that this relationships adds additional layers to an already complex presenting pain syndrome.

Our findings are not the first to highlight the link between physical and emotional health, yet our findings uniquely implicate that this is not simply an intrinsic disturbance within the affected individual. Rather it brings the experience of pain and PTSD symptomatology into the social realm, whereby pain and distress may be elicited by witnessing the suffering of others. This is a novel finding and has the potential to inform the understanding of social functioning in the context of chronic pain following trauma, particularly if it leads to avoidance or social isolation.
Although these studies were the first to demonstrate a link between PTSD symptoms and vicarious reactivity following amputation, we did not find PTSD symptoms to explain vicarious reactivity in all cases. In the absence of PTSD experiences it is likely that traits such as empathy and anxiety play a role. Future research will be needed to explore the role of traits in mediating vicarious reactivity in those who have been exposed to life threatening trauma, as well as in the general population.

Overall, our finding of a relationship between PTSD symptoms and vicarious reactivity in amputees will be important to keep in mind when rehabilitating and treating complex patients in civilian and veteran settings. These patients may require tailored treatment and coping strategies to manage these unpleasant experiences.

Discussion questions

  • What are the common mechanisms linking chronic disabling pain, PTSD and vicarious reactivity, and what mechanisms might explain vicarious reactivity in those with low PTSD (e.g., trait empathy?)?
  • Are alternative treatment approaches required to manage these complex interacting symptoms?


Author biography

Dr. Melita Giummarra (BA(hons), PhD)
is a National Health and Medical Research Council cognitive neuroscientist in the School of Psychological Sciences at Monash University, Australia. Her research focusses on empathy, pain, vicarious trauma and trauma recovery.

Dr. Bernadette Fitzgibbon ((BA (Hons), MSc, PhD)
is a National Health and Medical Research Council early career researcher at Monash University, Australia. Her research focuses on translational pain research and exploring how models of social cognition may help us to better understand our own and other’s pain.

Reference Article

Giummarra MJ, Fitzgibbon BM, Tsao JW, et al. Symptoms of PTSD Associated With Painful and Nonpainful Vicarious Reactivity Following Amputation. Journal of Traumatic Stress. 2015;28(4):330-338.