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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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Leem J, Sul J, Kang B. Observational study of Home-Based Integrative Korean Medicine Program to Satisfy Unmet Healthcare needs of Persons with Disability. Explore (NY) 2022; 18:327-334. [DOI: 10.1016/j.explore.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/06/2021] [Accepted: 01/21/2022] [Indexed: 11/27/2022]
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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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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] [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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He C, Tang QX, Li YX, He K, Hou ZL. Effectiveness of electroacupuncture for pain after osteosarcoma post surgery: A study protocol of systematic review of randomized controlled trial. Medicine (Baltimore) 2019; 98:e17381. [PMID: 31689744 PMCID: PMC6946390 DOI: 10.1097/md.0000000000017381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study will assess the effectiveness of electroacupuncture (EA) for pain in patients with osteosarcoma post surgery (OSPS). METHODS In this study, we will comprehensively search the following electronic databases from inception to the present without language restrictions: Cochrane Library, EMBASE, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database. Two authors will independently carry out study selection, data extraction, and methodological assessments. RevMan 5.3 software will be used for statistical analysis. RESULTS The primary outcome is pain intensity. The secondary outcomes consist of event-free survival, overall survival, quality of life, and adverse events. CONCLUSION The findings of this study will provide helpful evidence of EA treatment for patients with OSPS. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019146696.
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Affiliation(s)
- Chi He
- Department of Anesthesiology
| | - Qing-xi Tang
- Department of Emergency Surgery, First Affiliated Hospital of Jiamusi University, Jiamusi
| | - Ying-xia Li
- Department of Emergency Surgery, First Affiliated Hospital of Jiamusi University, Jiamusi
| | - Kai He
- Department of Orthopedis, Harbin Second Hospital, Harbin, 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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POOR ZAMANY NEJATKERMANY M, MODIRIAN E, SOROUSH M, MASOUMI M, HOSSEINI M. Phantom Limb Sensation (PLS) and Phantom Limb Pain (PLP) among Young Landmine Amputees. IRANIAN JOURNAL OF CHILD NEUROLOGY 2016; 10:42-7. [PMID: 27375755 PMCID: PMC4928615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the frequency of phantom limb sensation (PLS) and phantom limb pain (PLP) in children and young adults suffering landmine-related amputation. MATERIALS & METHODS All youths with amputation due to landmine explosions participated in this study. The proportions of patients with phantom limb sensation/pain, intensity and frequency of pain were reported. Chi square test was used to examine the relationship between variables. Comparison of PLP and PLS between upper and lower amputation was done by unpaired t-test. RESULTS There were 38 male and 3 female with the mean age of 15.8±2.4yr. The mean interval between injury and follow-up was 90.7±39.6 months. Twelve (44.4%) upper limb amputees and 11 (26.8%) lower limb amputees had PLS. Nine (33.3%) upper limb amputees and 7 (17.1%) lower limb amputees experienced PLP. Of 27 upper limb amputees, 6 (14.6%) and among 15 lower limb amputees, 6 (14.6%) had both PLS and PLP. One case suffered amputation of upper and lower limbs and was experiencing PLS and PLP in both parts. PLS had a significant difference between the upper and lower amputated groups. Significant relationship was observed between age of casualty and duration of injury with PLP. CONCLUSION Phantom limb sensation and pain in young survivors of landmine explosions appear to be common, even years after amputation.
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Affiliation(s)
| | - Ehsan MODIRIAN
- Emergency Medicine Department, Boali Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Mehdi MASOUMI
- Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
| | - Maryam HOSSEINI
- Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
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Tibioperoneal Short Circuiting for Stump Neuroma Pain in Amputees: Revival of an Old Technique. World Neurosurg 2015; 84:681-7. [PMID: 25937355 DOI: 10.1016/j.wneu.2015.04.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/12/2015] [Accepted: 04/16/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Stump neuroma pain in amputees can be quite challenging. Surgical treatment may be largely subdivided into neuromodulative and non-neuromodulative methods. The latter includes neurocapsis, insertion of nerve stump into the bone marrow, centro-central short circuit (CCSC), and coverage with vascularized soft tissue flaps. CCSC was shown to be extremely effective in alleviation of pain. Reports on CCSC for the treatment of stump neuroma pain have disappeared from the literature, with a shift toward neuromodulation for the treatment of pain irrespective of etiology. METHODS We observed 8 lower limb amputees undergoing CCSC of the sciatic nerve during a follow-up of 12 years. All had the same stump neuroma pain rendering them unable to wear their prostheses. The sciatic nerve was explored at the midthigh area, much proximal to the amputation site, and a short circuit was established between the tibial and peroneal parts of the nerve. Assessment was by means of pain quantification as per the quadruple visual analogue scale, medication intake, and ability to use prostheses. RESULTS The median worst quadruple visual analogue scale before surgery was 8.0. After surgery it decreased to 2.5 (P = 0.00094). Medication intake was reduced from regular intake of a combination of opioids, nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, and pregabalin in all patients to irregular intake of nonsteroidal anti-inflammatory drug alone in 3 of 8 patients. All patients were able to wear their limb prosthesis since surgery. CONCLUSIONS CCSC is a simple, effective, and long-lasting method to treat painful stump neuromas in amputees. It should be strongly considered in deserving cases before resorting to neuromodulative methods.
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Kurath-Koller S, Bauchinger S, Sperl D, Leithner A, Urlesberger B, Raith W. Use of NADA ear acupuncture in an adolescent patient with phantom limb pain after surgery for osteosarcoma. Acupunct Med 2014; 33:82-4. [PMID: 25520279 DOI: 10.1136/acupmed-2014-010710] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- S Kurath-Koller
- Research Group for Paediatric Traditional Chinese Medicine, TCM Research Centre Graz (Acupuncture Research), Medical University of Graz, Graz, Austria Division of General Pediatrics, Department of Paediatrics, Medical University of Graz, Graz, Austria
| | - S Bauchinger
- Division of Hematology/Oncology, Department of Paediatrics, Medical University of Graz, Graz, Austria
| | - D Sperl
- Division of Hematology/Oncology, Department of Paediatrics, Medical University of Graz, Graz, Austria
| | - A Leithner
- Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria
| | - B Urlesberger
- Research Group for Paediatric Traditional Chinese Medicine, TCM Research Centre Graz (Acupuncture Research), Medical University of Graz, Graz, Austria Division of Neonatology, Department of Paediatrics, Medical University of Graz, Graz, Austria
| | - W Raith
- Research Group for Paediatric Traditional Chinese Medicine, TCM Research Centre Graz (Acupuncture Research), Medical University of Graz, Graz, Austria Division of Neonatology, Department of Paediatrics, Medical University of Graz, Graz, Austria
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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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