Prevalence of Low Back Pain and Relationship to Mental Health Symptoms and Quality of Life After a Deployment-related Lower Limb Amputation

Brittney Mazzone*, Shawn Farrokhi, Brad D. Hendershot, Cameron T. McCabe, Jessica R. Watrous

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Study Design. Retrospective, cross-sectional study. Objective. To assess the prevalence and association of low back pain (LBP) with psychosocial factors in Service members with amputations. Summary of Background Data. LBP is a common secondary health condition after amputation with important implications related to function and quality of life. A growing body of evidence suggests that psychosocial factors influence LBP in patients without amputation. However, there is a dearth of information regarding the association of psychosocial factors and LBP after amputation. Methods. Seventy-nine individuals with lower limb amputations who were a part of the Wounded Warrior Recovery Project were included in the analysis. Data on posttraumatic stress disorder (PTSD), depression, and quality of life (QOL) were collected from the Wounded Warrior Recovery Project, while data on LBP and LBP chronicity were extracted from the Military Health System Data Repository. General linear models were utilized to analyze associations between LBP and psychosocial factors, while controlling for injury severity and time since amputation. Results. In individuals with amputations, 19.0% had acute LBP and 49.4% had recurrent LBP. Individuals with amputations and recurrent LBP reported higher PTSD symptom severity compared with those without LBP (B = 9.213, P < 0.05). More severe depression symptoms were observed in those with amputations and recurrent LBP compared with those without LBP (B = 5.626, P < 0.05). Among individuals with amputations, those with recurrent LBP reported lower QOL compared with those without LBP (B = -0.058, P < 0.05). There were no differences in PTSD, depression or QOL in those with amputations with and without acute LBP. Conclusions. Presence of recurrent LBP after amputation appears to be associated with more severe PTSD and depression symptoms as well as lower QOL. Further research is needed to assess the efficacy of addressing psychosocial factors for improving pain and function in service members with amputations and LBP. Level of Evidence: 3.

Original languageEnglish
Pages (from-to)1368-1375
Number of pages8
Issue number19
StatePublished - 1 Oct 2020
Externally publishedYes


  • anxiety
  • back pain
  • combat
  • depression
  • limb loss
  • military
  • posttraumatic stress disorder
  • psychosocial
  • service members
  • veterans


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