{
  "abstract": "Phantom limb pain (PLP) is common after amputation, yet why poor sleep becomes pain in only some individuals is unknown. We hypothesized that a regulatory response is interpretable only against the reserve sustaining it, and thus we tested whether autonomic capacity relative to demand moderates the sleep-pain relationship in 121 amputee adults. Sleep was assessed with the Pittsburgh Sleep Quality Index; PLP, residual limb pain (RLP), and phantom limb sensation (PLS) on 0-10 scales. Heart rate variability was summarized as autonomic reserve (log-transformed SDNN, RMSSD, total and high-frequency power) and autonomic drive (normalized low-frequency power). Poorer sleep was associated with greater PLP and RLP, but not PLS. No single HRV index moderated these associations, but the sleep x reserve x drive interaction did for PLP (b = -0.51, p = 0.026). Poor sleep predicted pain most strongly under high drive with reduced reserve. PLP vulnerability reflects autonomic capacity relative to demand, instead of any single HRV marker alone.",
  "abstract_shown": true,
  "affiliations": [
    "Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "name": "N. Aranis"
    },
    {
      "name": "M. Holmes"
    },
    {
      "name": "A. L. Gianlorenco"
    },
    {
      "name": "D. Sparrow"
    },
    {
      "name": "D. Crandell"
    },
    {
      "name": "W. Caumo"
    },
    {
      "affs": [
        0
      ],
      "name": "F. Fregni"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bx4nrs738j17e.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.06.26364856",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.06.26364856v1.full",
  "id": "bx4nrs738j17e",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.06.26364856v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "neurology"
    ],
    [
      "openalex",
      "2703|Pain Management and Treatment"
    ]
  ],
  "openalex": "W7220939934",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.06.26364856v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-06",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/bx4nrs738j17e.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:29Z",
      "native_id": "10.64898/2026.10.06.26364856",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.06.26364856v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:neurology",
      "subfield": "neurology"
    }
  ],
  "title": "Compensatory drive and sleep-related phantom limb pain: the moderating role of autonomic reserve",
  "title_text": "Compensatory drive and sleep-related phantom limb pain: the moderating role of autonomic reserve",
  "type": "preprint",
  "updated_at": "2026-10-30T12:20:29Z",
  "url": "https://research.draconitic.com/paper/bx4nrs738j17e",
  "venue": "medRxiv",
  "versions": []
}