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Huang H, Yu Y, Peng Y, Fu Z. Ten-year phantom limb pain with only four sessions of Fu's subcutaneous needling: A case report and systematic review. Explore (NY) 2024; 20:513-519. [PMID: 38008590 DOI: 10.1016/j.explore.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/18/2023] [Indexed: 11/28/2023]
Abstract
Phantom limb pain (PLP) is a distressing consequence commonly encountered by individuals who have undergone amputations. The efficacy of treatment options for PLP is limited. In this study, we present a case of a 64-year-old male who suffered from PLP for a duration of 10 years following an above-the-knee amputation. Despite unsuccessful attempts with painkillers and neurotrophic drugs over the course of a decade, the patient sought relief through Fu's Subcutaneous Needling (FSN), an innovative acupuncture therapy that specifically targets the subcutaneous tissue for pain management. Remarkably, the patient experienced a significant reduction in PLP and subsequently decreased his reliance on medication, as well as experiencing improved sleep after undergoing one session of FSN per day for four consecutive days. A follow-up conducted three years later demonstrated positive treatment outcomes. FSN demonstrated a significant influence on PLP, resulting in reduced analgesic requirements and enhanced quality of life. Therefore, FSN may be recommended as an additional treatment option for PLP. In order to gain a comprehensive understanding of the effects of acupuncture on PLP, a systematic review of relevant literature was conducted in PubMed, Embase, Cochrane Library and Web of Science in recent 20 years (from January 1, 2003 to October 16, 2023), using different combinations of the following terms: (phantom acrodynia), (residual limb pain), (phantom limb pain), (acupuncture), (electroacupuncture), (auriculoacupuncture), and (needling). 9 articles with 18 cases including one randomized controlled trial (n = 8) were obtained. This review provided additional evidence supporting the efficacy and safety of needling therapies for PLP. This systematic review offers additional evidence supporting the effectiveness and safety of needling therapies for PLP. However, there were no precedent reports using FSN treatment for PLP. Hence, this case may provide some implications for clinicians in practice.
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Affiliation(s)
- Huiyi Huang
- Clinical Medical College of Acupuncture & Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yongguang Yu
- Wuyuan County People's Hospital, Shangrao, Jiangxi, China
| | - Yuetong Peng
- Clinical Medical College of Acupuncture & Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhonghua Fu
- Clinical Medical College of Acupuncture & Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China; The Institute of Fu's Subcutaneous Needling, Beijing University of Chinese Medicine, Beijing, China.
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2
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Fatma Ö, Tekin E, Uran Şan A, Demir Y, Aydemir K, Kesikburun S. The Efficacy of Acupuncture on Pain and Functional Status in Patients with Lower Extremity Amputation with Stump Neuroma: A prospective randomised controlled pilot study. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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3
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Guo Q, Di Z, Tian HF, Zhang QA. Contralateral Acupuncture for the Treatment of Phantom Limb Pain and Phantom Limb Sensation in Oncologic Lower Limb Amputee: A Case Report. Front Neurosci 2021; 15:713548. [PMID: 34744604 PMCID: PMC8568952 DOI: 10.3389/fnins.2021.713548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Phantom limb pain (PLP) and phantom limb sensation (PLS) are common and distressing sequelae of amputation. Current pain management following amputation is challenging and unsatisfying. In this case study, a 74-year-old woman underwent above-knee amputation because of the rhabdomyosarcoma in the right leg. Despite several analgesics, pain was poorly controlled. The phantom limb pain and sensation were immediately reduced by the contralateral acupuncture, and abolished after the third session with no side-effects, no relapse during the next 9 months. Contralateral acupuncture showed positive effect on PLP and PLS in this case, but more robust evidence would be needed to support the efficacy of this treatment technique for indication.
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Affiliation(s)
- Qin Guo
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhong Di
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hong-Fang Tian
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Quan-Ai Zhang
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Hyung B, Wiseman-Hakes C. A scoping review of current non-pharmacological treatment modalities for phantom limb pain in limb amputees. Disabil Rehabil 2021; 44:5719-5740. [PMID: 34293999 DOI: 10.1080/09638288.2021.1948116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Phantom limb pain (PLP) is a chronic neuropathic pain condition of a missing limb following amputation. Pain management is multi-modal, including various non-pharmacological therapies. The purpose of this scoping review was to investigate the evidence surrounding current non-pharmacological treatment modalities for PLP and provide insight into their clinical feasibility. METHOD A systematic search was conducted using four databases (Medline, Embase, PsychInfo, and CINAHL) following the PRISMA-ScR method. Results from papers meeting the inclusion criteria were charted to summarize findings, demographics, and use of neuroimaging. RESULTS A total of 3387 papers were identified, and full texts of 142 eligible papers were assessed. Eleven treatment modalities for PLP were identified with varying levels of evidence. Overall, there were 25 RCTs, 58 case reports, and 59 a combination of pilot, quasi-experimental, observational, and other study designs. CONCLUSIONS Currently, the evidence surrounding most treatment modalities is limited and only a fraction of studies are supported by strong evidence. The findings of this review demonstrated a clear need to conduct more rigorous research with diverse study designs to better understand which modalities provide the most benefit and to incorporate neuroimaging to better determine the neural correlates of PLP and mechanisms of various treatments.Implications for RehabilitationPhantom limb pain (PLP) is a prevalent and debilitating condition following amputation and health care professionals should incorporate an evidence-based pain management protocol into their rehabilitation program.There exist a number of different non-pharmacological therapies to address PLP, however the scientific rigor and levels of evidence vary across modalities.Prescription of interventions for PLP should consider individual patient differences, accessibility to the patient, and quite possibly, a multi-modal approach, particularly for those who also experience residual limb pain.Imagery-based therapies provide the highest level of current evidence based on robust and large randomized control trials, are readily accessible, and are thus most recommended for relief of PLP.
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Affiliation(s)
- Brian Hyung
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Catherine Wiseman-Hakes
- School of Rehabilitation Sciences Institute, McMaster University, Hamilton, Canada.,KITE-University Health Network, Toronto Rehabilitation Institute, Toronto, Canada
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Tian H, Hu H, Li X, Liu J, Guo Q, Li Y, Han D. Auricular Therapy for Treating Phantom Limb Pain Accompanied by Jumping Residual Limb: A Short Review and Case Study. Pain Ther 2021; 10:739-749. [PMID: 33661513 PMCID: PMC8119544 DOI: 10.1007/s40122-021-00236-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/15/2021] [Indexed: 12/18/2022] Open
Abstract
Phantom limb pain (PLP) is a common complaint among patients after amputation, while jumping residual limb is a rare post-amputation complication, they rarely happen at the same time and both remain difficult to manage. At present, there is a paucity of literature on this topic, and no treatment has been proven effective for treating both of them. In the present brief report, we described a patient who developed severe PLP accompanied by jumping residual limb after below-the-knee amputation and she was treated by auricular therapy (AT) with satisfactory effect.
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Affiliation(s)
- Hongfang Tian
- Department of Acupuncture and Moxibustion, Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - Hantong Hu
- Department of Acupuncture and Moxibustion, Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - Xingling Li
- Department of Acupuncture and Moxibustion, Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - Jing Liu
- Department of Acupuncture and Moxibustion, Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - Qin Guo
- Department of Acupuncture and Moxibustion, Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - Yang Li
- Department of Acupuncture and Moxibustion, Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - Dexiong Han
- Department of Acupuncture and Moxibustion, Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China.
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Kuffler DP. Can phantom limb pain be reduced/eliminated solely by techniques applied to peripheral nerves? JOURNAL OF NEURORESTORATOLOGY 2019. [DOI: 10.26599/jnr.2019.9040002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
About 0.5% of the US population (1.7 million) is living with a lost limb and this number is expected to double by 2050. This number is much higher in other parts of the world. Within days to weeks of an extremity amputation, up to 80% of these individuals develop neuropathic pain presenting as phantom limb pain (PLP). The level of PLP increases significantly by one year and remains chronic and severe for about 10% of individuals. PLP has a serious negative impact on individuals’ lives. Current pain treatment therapies, such pharmacological approaches provide limited to no pain relief, some other techniques applied to the central nervous system (CNS) and peripheral nervous system (PNS) reduce or block PLP, but none produces long-term pain suppression. Therefore, new drugs or novel analgesic methods must be developed that prevent PLP from developing, or if it develops, to reduce the level of pain. This paper examines the potential causes of PLP, and present techniques used to prevent the development of PLP, or if it develops, to reduce the level of pain. Finally it presents a novel technique being developed that eliminates/reduces chronic neuropathic pain and which may induce the long-term reduction/elimination of PLP.
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Flahaut M, Laurent NL, Michetti M, Hirt-Burri N, Jensen W, Lontis R, Applegate LA, Raffoul W. Patient care for postamputation pain and the complexity of therapies: living experiences. Pain Manag 2018; 8:441-453. [PMID: 30175653 DOI: 10.2217/pmt-2018-0033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM Limb amputation traumatically alters body image. Sensations rapidly prevail that the limb is still present and 85% of patients portray phantom limb pain. Throughout the testimonies of amputated patients with intense phantom limb pain, we show the difficulty in treating this chronic pain with current pharmacological and nonpharmacological therapies. PATIENTS & METHODS We qualitatively analyzed the therapeutic choices of five amputees, the effectiveness of the treatments chosen and the impact on patients' quality-of-life. RESULTS & CONCLUSION In general, patients who are refractory to pharmacological treatments are in favor of trying alternative therapies. It is therefore crucial to design a combined and personalized therapeutic plan under the coordination of a multidisciplinary team for the wellbeing of the patient.
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Affiliation(s)
- Marjorie Flahaut
- Department of Plastic, Reconstructive & Hand Surgery, Unit of Regenerative Therapy, University Hospital of Lausanne, 1066 Epalinges, Switzerland
| | - Nicolas L Laurent
- Department of Plastic, Reconstructive & Hand Surgery, Unit of Regenerative Therapy, University Hospital of Lausanne, 1066 Epalinges, Switzerland
| | - Murielle Michetti
- Department of Plastic, Reconstructive & Hand Surgery, Unit of Regenerative Therapy, University Hospital of Lausanne, 1066 Epalinges, Switzerland
| | - Nathalie Hirt-Burri
- Department of Plastic, Reconstructive & Hand Surgery, Unit of Regenerative Therapy, University Hospital of Lausanne, 1066 Epalinges, Switzerland
| | - Winnie Jensen
- Department of Health Science & Technology, Center for Sensory-Motor Interaction, Aalborg University, 9000 Aalborg, Denmark
| | - Romulus Lontis
- Department of Health Science & Technology, Center for Sensory-Motor Interaction, Aalborg University, 9000 Aalborg, Denmark
| | - Lee A Applegate
- Department of Plastic, Reconstructive & Hand Surgery, Unit of Regenerative Therapy, University Hospital of Lausanne, 1066 Epalinges, Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive & Hand Surgery, Unit of Regenerative Therapy, University Hospital of Lausanne, 1066 Epalinges, Switzerland
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El Aziz Labeeb AA, Casale R. Treatment of phantom pain with contralateral injection into tender points: a new method of treatment. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2015. [DOI: 10.4103/1110-161x.163929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lee IS, Jung WM, Lee YS, Wallraven C, Chae Y. Brain responses to acupuncture stimulation in the prosthetic hand of an amputee patient. Acupunct Med 2015; 33:420-4. [PMID: 26033865 DOI: 10.1136/acupmed-2015-010785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2015] [Indexed: 11/03/2022]
Abstract
This report describes the brain responses to acupuncture in an upper limb amputee patient. A 62-year-old male had previously undergone a lower left arm amputation following an electrical accident. Using functional MRI, we investigated brain responses to acupuncture stimulation in the aforementioned amputee under three conditions: (a) intact hand, (b) prosthetic hand (used by the patient), and (c) fake fabric hand. The patient described greater de qi sensation when he received acupuncture stimulation in his prosthetic hand compared to a fake hand, with both stimulations performed in a similar manner. We found enhanced brain activation in the insula and sensorimotor cortex in response to acupuncture stimulation in the amputee's prosthetic hand, while there was only minimal activation in the visual cortex in response to acupuncture stimulation in a fake hand. The enhanced brain responses to acupuncture stimulation of the patient's prosthetic hand might be derived from cortical reorganisation, as he has been using his prosthetic hand for over 40 years. Our findings suggest the possible use of acupuncture stimulation in a prosthetic hand as an enhanced sensory feedback mechanism, which may represent a new treatment approach for phantom limb pain.
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Affiliation(s)
- In-Seon Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Korea Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany IMPRS for Cognitive and Systems Neuroscience, Universität Tübingen, Tübingen, Germany
| | - Won-Mo Jung
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Ye-Seul Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Christian Wallraven
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Korea Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
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Tian S, Nick S, Wu H. Phantom limb pain: A review of evidence-based treatment options. World J Anesthesiol 2014; 3:146-153. [DOI: 10.5313/wja.v3.i2.146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/11/2014] [Accepted: 03/12/2014] [Indexed: 02/06/2023] Open
Abstract
Phantom limb pain (PLP) is not uncommon after amputation. PLP is described as a painful sensation perceived in the missing limb. Despite of its complicated pathophysiology, high prevalence of PLP has been associated with poor health-related quality of life, low daily activity and short walking distances. A prompt and effective management of PLP is essential in caring for the amputee population. Current treatments including physical therapy, psychotherapy, medications, and interventions have been used with limited success. In this review, we provided an updated and evidence-based review of treatment options for PLP.
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11
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The effectiveness of acupuncture or TENS for phantom limb syndrome. II: A narrative review of case studies. Eur J Integr Med 2014. [DOI: 10.1016/j.eujim.2014.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Tseng CC, Chen PY, Lee YC. Successful treatment of phantom limb pain and phantom limb sensation in the traumatic amputee using scalp acupuncture. Acupunct Med 2014; 32:356-8. [PMID: 24855097 PMCID: PMC4145449 DOI: 10.1136/acupmed-2014-010556] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Chi-Chuan Tseng
- Division of Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pin-Yeh Chen
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ching Lee
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
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Farr J, Jaggers R, Lewis H, Plackis A, Sim SB, Sherman SL. Evidence-based approach of treatment options for postoperative knee pain. PHYSICIAN SPORTSMED 2014; 42:58-70. [PMID: 24875973 DOI: 10.3810/psm.2014.05.2058] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Optimal pain management is critical after knee surgery to avoid adverse events and to improve surgical outcomes. Pain may affect surgical outcomes by contributing to limitations in range of motion, strength, and functional recovery. The causes of postoperative pain are multifactorial; therefore, an appropriate pain management strategy must take into account preoperative, intraoperative, and postoperative factors to create a comprehensive and individualized plan for the patient. Preoperative assessment includes management of patient expectations, recognition of conditions and early counseling for high-risk patients (ie, opioid dependence, psychiatric comorbidities), and use of preemptive analgesia techniques (ie, preoperative IV medications, peripheral nerve blocks, incisional field blocks). Intraoperative strategies include meticulous surgical technique, limiting the use of tourniquets (ie, duration and pressure), and using preventive analgesia methods (ie, postoperative field block, continuous nerve catheters, intra-articular injection). Postoperative analgesia may be facilitated by cryotherapy, early mobilization, bracing, and rehabilitation. Certain modalities (ie, continuous passive motion devices, transcutaneous electrical nerve stimulation units, iontophoresis) may be important adjuncts in the perioperative period as well. There may be an evolving role for alternative medicine strategies. Early recognition and treatment of exaggerated postoperative pain responses may mitigate the effects of complex regional pain syndrome or the development of chronic pain.
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Affiliation(s)
- Jack Farr
- Cartilage Restoration Center of Indiana, Greenwood, IN
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Pasquina PF, Miller M, Carvalho AJ, Corcoran M, Vandersea J, Johnson E, Chen YT. Special Considerations for Multiple Limb Amputation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014; 2:273-289. [PMID: 25411651 PMCID: PMC4228106 DOI: 10.1007/s40141-014-0067-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
It has been estimated that more than 1.6 million individuals in the United States have undergone at least one amputation. The literature abounds with research of the classifications of such injuries, their etiologies, epidemiologies, treatment regimens, average age of onset (average age of amputation), and much more. The subpopulation that is often overlooked in these evaluations, however, is comprised of individuals who have suffered multiple limb loss. The challenges faced by those with single-limb loss are amplified for those with multiple limb loss. Pain, lifestyle adjustment, and quality of life return are just a few key areas of concern in this population. Along with amputations resulting from trauma, many individuals with multiple amputations have endured them as a result of dysvascular disease. Over recent years, amputations as a result of dysvascular disease have risen to comprise more than 80 % of new amputations occurring in the United States every year. This compares to just 54 % of total current prevalence. Those with diabetes comorbid with dysvascular disease make up 74 % of those with dysvascular amputations, and these individuals with diabetes comorbid with dysvascular disease have a 55 % chance of enduring an amputation of their contralateral limb within 2-3 years of their initial amputation. With the well-documented aging of the nation's population and the similarly skyrocketing prevalence of dysvascular disease and diabetes, it can be expected that the number of individuals with multiple limb loss will continue to increase in the United States. This article outlines the recommended measures of care for this particular subpopulation, including pain management, behavioral health considerations, strategies for rehabilitation for various levels and variations of multiple limb loss, and the assistive technology and adaptive equipment that might be available for these individuals to best enable them to continue healthy, fulfilling lives following amputation.
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Affiliation(s)
- Paul F. Pasquina
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD USA
- Center for Rehabilitation Sciences Research (CRSR), Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Matthew Miller
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD USA
- Center for Rehabilitation Sciences Research (CRSR), Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - A. J. Carvalho
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
- Center for Rehabilitation Sciences Research (CRSR), Uniformed Services University of the Health Sciences, Bethesda, MD USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA
| | - Michael Corcoran
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD USA
- Medical Orthotics and Prosthetics, Silver Spring, MD USA
| | - James Vandersea
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD USA
- Advanced Arm Dynamics, Bethesda, MD USA
| | - Elizabeth Johnson
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
- Center for Rehabilitation Sciences Research (CRSR), Uniformed Services University of the Health Sciences, Bethesda, MD USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA
| | - Yin-Ting Chen
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD USA
- Center for Rehabilitation Sciences Research (CRSR), Uniformed Services University of the Health Sciences, Bethesda, MD USA
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Abstract
The use of visual illusions to study how the brain gives rise to a representation of the body has produced surprising results, particularly in relation to modulation of pain. It seems likely that this research has relevance to how we understand acupuncture analgesia. Acupuncture supplies several different kinds of signal to the brain: touch in the preliminary examination for tender areas; needle stimulation, mainly of Aδ fibres; and sometimes visual input from the patient's sight of the needle insertion. In the light of recent research, all these are likely to modulate pain. There are implications here for clinical practice and for research. Acupuncture may be more effective if patients can see the needles being inserted. The use of non-penetrating stimuli to the skin or minimal needle insertion at non-acupuncture points as control procedures becomes more than ever open to question and this, in turn, has relevance for claims that acupuncture is indistinguishable from placebo.
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