Phantom Fighters: Coping Mechanisms of Amputee Patients with Phantom Limb Pain: A Longitudinal Study

DOI: 10.4236/ojo.2013.37055   PDF   HTML     4,078 Downloads   6,874 Views   Citations


Phantom Limb Pain (PLP) is a phenomenon commonly observed in orthopedic rehabilitation units that can have detrimental effects on patients’ functioning. Psychological aspects of PLP have been widely investigated showing that some coping mechanisms are advantageous at certain points but not at others. However, the mechanisms related to positive adjustment to PLP during the course of rehabilitation have not been adequately examined. The aim of the study was to investigate the relationship between PLP and coping mechanism at two points during the rehabilitation process. Thirty one orthopedic inpatients, who had undergone lower-limb amputation following diabetic complications, rated their pain levels and mental coping strategies. The Ways of Coping Checklist, Life Orientation Test, and the McGill Pain Questionnaire, 1-15 days post-surgery and six months post-surgery were used for evaluation. Denial was found to be negatively correlated with PLP shortly after amputation. In contrast, optimism was found to be negatively correlated with PLP six months after the surgery. Emotion-focused coping mechanisms were found to be positively correlated with PLP. It is concluded that denial during the early stages of recuperation and optimism at later stages of rehabilitation is associated with reduced PLP. Awareness of these mental processes by both medical staff and family members may enable acceptance of these processes and thus facilitate patients’ rehabilitation.

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D. Margalit, E. Heled, C. Berger and H. Katzir, "Phantom Fighters: Coping Mechanisms of Amputee Patients with Phantom Limb Pain: A Longitudinal Study," Open Journal of Orthopedics, Vol. 3 No. 7, 2013, pp. 300-305. doi: 10.4236/ojo.2013.37055.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] I. Pucher, W. Kickinger and O. J. Frischenschlager, “Coping with Amputation And Phantom Limb Pain,” Journal of Psychosomatic Research Vol. 46, No. 4, 1999, pp. 379-383.
[2] C. Richardson, S. Glenn, M. Horgan and T. Nurmikko, “A Prospective Study of Factors Associated with the Presence of Phantom Limb Pain Six Months after Major Lower Limb Amputation in Patients with Peripheral Vascular Disease,” Journal of Pain Vol. 8, No. 10, 2007, pp. 793-801.
[3] R. A. Sherman, C. J. Sherman and I. Parker, “Chronic Phantom and Stump Pain Among American Veterans: Results of A Survey,” Pain, Vol. 18, No. 1, 1984, pp. 1883-1895.
[4] M. A. Hanley, M. P. Jensen, D. M. Ehde, A. J. Hoffman D. R. Patterson and L. R. Robinson, “Psychosocial Predictors of Long-Term Adjustment to Lower-Limb Amputation and Phantom Limb Pain,” Disability and Rehabilitation, Vol. 26, No. 14-15, 2004, pp. 882-893.
[5] R. Casale, L. Alaa, M. Mallick and H. Ring, “Phantom Limb Related Phenomena and Their Rehabilitation after Lower-Limb Amputation,” European Journal of Physical and Rehabilitation Medicine, Vol. 45, No. 4, 2009, pp. 559-566.
[6] R. A. Carabelli and W. C. Kellerman, “Phantom Limb Pain Relief by Tens to Contralateral Extremity,” Archives of Physical Medicine and Rehabilitation, Vol. 66, No. 7, 1985, pp. 466-467.
[7] S. Millstein, D. Bain and G. A. Hunter “A Review of Employment Patterns of Industrial Amputees—Factors Influencing Rehabilitation,” Prosthetics and Orthotics International, Vol. 9, No. 2, 1985, pp. 69-78.
[8] C. M. Parkes “Factors Determining The Persistence of Phantom Pain in The Amputee,” Journal of Psychosomatic Research, Vol. 17, No. 2, 1973, pp. 97-108.
[9] C. P. Van der Schans, J. H. B. Geertzen, T. Schoppen and P. U. Djikstra, “Phantom Pain and Health-Related Quality of Life in Lower Limb Amputees,” Journal of Pain and Symptom Management, Vol. 24, No. 4, 2002, pp. 429-436.
[10] M. Marshall, E. Helmes and A. B. Deathe, “Comparison of Psychosocial Functioning and Personality in Amputee and Chronic Pain Populations,” The Clinical Journal of Pain, Vol. 8, No. 4, 1992, pp. 351-357.
[11] A. S. Whyte and L. J. Carroll, “The Relationship between Catastrophizing and Disability in Amputees Experiencing Phantom Pain,” Disability and Rehabilitation, Vol. 26, No. 11, 2004, pp. 649-654.
[12] J. Katz and L. Gagliese, “Phantom Limb Pain: A Continuing Puzzle,” In: R. J. Gatchel and D. C. Turk, Eds., Psychosocial Factors in Pain: Critical Perspectives, Guilford Press, New York, 1999, pp. 284-300.
[13] A. Hill, C. A. Niven and C. Knussen, “The Role of Coping in Adjustment to Phantom Limb Pain,” Pain, Vol. 62, No. 1 1995, pp. 79-86.
[14] M. P. Jensen, D. M. Ehde, A. J. Hoffman, D. R. Patterson, J. M. Czerniecki and L. R. Robinson, “Cognitions, Coping and Social Environment Predict Adjustment to Phantom Limb Pain,” Pain, Vol. 95, No. 1, 2002, pp. 133-142.
[15] Z. M. Hawamdeh, Y. S. Othman and A. I. Ibrahim, “Assessment of Anxiety and Depression after Lower Limb Amputation in Jordanian Patients,” Neuropsychiatric Disease and Treatment, Vol. 4, No. 3, 2008, pp. 627-633.
[16] B. Darnall, P. Ephraim, S. T. Wegener, et al., “Depressive Symptoms and Mental Health Service Utilization Among Persons with Limb Loss: Results of A National Survey,” Archives of Physical Medicine and Rehabilitation, Vol. 86, No. 4, 2005, pp. 650-658.
[17] M. Asano, P. Rushton, W. C. Miller and B. A. Deathe, “Predictors of Quality of Life among Individuals who Have a Lower Limb Amputation,” Prosthetics and Orthotics International, Vol. 32, No. 2, 2008, pp. 231-243.
[18] P. V. Giannoudis, P. J. Harwood, G. Kontakis, et al., “Long-Term Quality of Life in Trauma Patients Following the Full Spectrum of Tibial Injury (Fasciotomy, Closed Fracture, Grade IIIB/IIIC Open Fracture and Amputation),” Injury, Vol. 40, No. 2, 2009, pp. 213-219.
[19] D. M. Desmond and M. MacLachlan, “Affective Distress and Amputation-Related Pain among Older Men with Long-Term, Traumatic Limb Amputations,” Journal of Pain Symptom Management, Vol. 31, No. 4, 2006, pp. 362-368.
[20] B. A. Arnow, C. M. Blasey, M. J. Constantino, et al., “Catastrophizing, Depression and Pain-Related Disability,” General Hospital Psychiatry, Vol. 33, No. 2, 2011, pp. 150-156.
[21] F. J. Keefe and D. A. Williams, “A Comparison of Coping Strategies in Chronic Pain Patients in Different Age Groups,” Journal of Gerontology, Vol. 45, No. 4, 1990, pp. 161-165.
[22] D. M. Desmond. “Coping, Affective Distress, and Psychosocial Adjustment among People with Traumatic Upper Limb Amputations,” Journal of Psychosomatic Research, Vol. 62, No. 1, 2007, pp. 15-21.
[23] C. S. Carver, M. F. Scheier and J. K. Weintraub, “Assessing Coping Strategies: A Theoretically Based Approach,” Journal of Personality and Social Psychology, Vol. 56, No. 6, 1989, pp. 267-283.
[24] R. S. Lazarus and S. Folkman, “Stress Appraisal, and Coping,” Springer Publishing Company, New York, 1984.
[25] I. Dudkiewicz, R. Gabrielov, I. Seiv-Ner, G. Zelig and M. Heim, “Evaluation of Prosthetic Usage in Upper Limb Amputees,” Disability and Rehabilitation, Vol. 26, No. 1, 2004, pp. 60-63.
[26] W. J. Gaine, C. Smart and M. Bransby-Zachary, “Upper Limb Traumatic Amputees. Review of Prosthetic Use,” Journal of Hand Surgery, Vol. 22, No. 1, 1997, pp 73-76.
[27] C. M Ga Kooijman, P. U. Dijkstra, J. H. B. Geertzen, A. Elzinga, C. P. van der Schans, “Phantom Pain and Phantom Sensations in Upper Limb Amputees: An Epidemiological Study,” Pain, Vol. 87, No. 1, 2000, pp. 33-41.
[28] M. F. Scheier and C. S. Carver, “Optimism, Coping, and Health: Assessment and Implications of Generalized Outcome Expectancies” Health Psychology, Vol. 4, No. 3, 1985, pp. 219-247.
[29] M. F. Scheier, C. S. Carver and M. W. Bridges, “Distinguishing Optimism from Neuroticism (and Trait Anxiety, Self-Mastery, and Self-Esteem): A reevaluation of the life orientation test,” Journal of Personality and Social Psychology, Vol. 67, No. 6, 1994, pp. 1063-1078.
[30] D. S. Dunn, “Well-being Following Amputation: Salutary Effects of Positive Meaning, Optimism, and Control,” Rehabilitation Psychology, Vol. 41, No. 4, 1996, pp. 285-302.
[31] O. Horgan and M. MacLachlan, “Psychosocial Adjustment to Lower-Limb Amputation: A Review,” Disability and Rehabilitation, Vol. 26, No. 14-15, 2004, pp. 837-850.
[32] A. MacBride, J. Rogers, B. Whylie and S. J. J. Freeman, “Psychosocial Factors in the Rehabilitation of Elderly Amputees,” Psychosomatics, Vol. 21, No. 3, 1989, pp. 258-265.
[33] B. Rybarczyk, R. Edwards and J. Behel, “Diversity in Adjustment to A Leg Amputation: Case Illustrations of Common Themes,” Disability and Rehabilitation, Vol. 26, No. 14-15, 2004, pp. 944-953.
[34] R. S. Lazarus, “The Costs and Benefits of Denial,” In: S. Breznitz, Ed., The Denial of Stress, International Universities Press, New York, 1983, pp. 1-30.
[35] E. Kubler-Ross, “On Death and Dying,” Macmillan, New York, 1968.
[36] H. Livneh, R. F. Antonak and J Gerhardt, “Psychosocial Adaptation to Amputation: The Role of Sociodemographic Variables, Disability-Related Factors, and Coping Strategies,” International Journal of Rehabilitation Research, Vol. 22, No. 1, 1999, pp. 21-31.
[37] C. Sjodahl, G. Gard and G. B. Jarnlo, “Coping after Trans-Femoral Amputation Due to Trauma or Tumor—A Phenomenological Approach,” Disability and Rehabilitation, Vol. 26, No. 14-15, 2004, pp. 851-861.
[38] J. Walters, “Coping with Leg Amputation,” American Journal of Nursing, Vol. 81, No. 7, 1981, pp. 1349-1352.
[39] P. P. Vitaliano, J. Russo, J. E. Carr, R. D. Maiuro and J. Becker, “The Ways of Coping Checklist: Revision and Psychometric Properties,” Multivariate Behavioral Research, Vol. 20, No. 1, 1985, pp. 3-26.
[40] Z. Solomon, E. Avitzur and M. Mikulincer, “Coping Resources and Social Function Following Combat Stress Reaction: A Longitudinal Study,” Journal of Social and Clinical Psychology, Vol. 8, No. 1, 1989, pp. 87-96.
[41] Z. German, “The Relationship between Procrastination and Guilt as A Basis for the Typology of Procrastinators and Non Procrastinators,” Ph.D. Thesis, Tel Aviv University, Tel Aviv, 1990.
[42] R. Melzack, “The McGill Pain Questionnaire: Major Properties and Scoring Methods,” Pain, Vol. 1, No. 3, 1975, pp. 277-299.
[43] R. Defrin, A. Ohry, N. M. Blumen and G. Urca, “Acute Pain Threshold in Participants with Chronic Pain Following Spinal Cord Injury,” Pain, Vol. 83, No. 2, 1999, pp. 275-282.
[44] A. Yaari, E. Eisenberg, R. Adler and J. Birkhan, “Chronic Pain in Holocaust Survivors,” Journal of Pain and Symptom Management, Vol. 17, No. 3, 1999, pp. 181-187.
[45] Y. P. Talmi, A. Waller, M. Bercovici, et al., “Pain Experienced by Patients with Terminal Head and Neck Carcinoma,” Cancer, Vol. 80, No. 6, 1997, pp. 1117-1123.<1117::AID-CNCR15>3.0.CO;2-B
[46] D. Arazi-Margalit, S. Rappaport, D. Neman, A. Fridman, Z. Tzadok, H. Azaryah, et al., “The Mental Reaction to Physical Disability,” In: A. Bleich and Z. Solomon, Eds. Mental Disability. Medical, Research, Social, Legal and Rehabilitative Aspects, Ministry of Defense Publication, Tel-Aviv, 2002, pp. 201-259.
[47] N. S. Endler and J. D. Parker, “A Multidimensional Assessment of Coping: A Critical Evaluation,” Journal of Personality and Social Psychology, Vol. 58, No. 5, 1990, pp. 844-854.

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