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The effectiveness of acupuncture or \ TENS\ for phantom limb syndrome. II: A narrative review of case studies

The effectiveness of acupuncture or \ TENS\ for phantom limb syndrome. II: A narrative review of case studies
The effectiveness of acupuncture or \ TENS\ for phantom limb syndrome. II: A narrative review of case studies
Introduction Phantom limb pain and phantom limb sensation are extremely prevalent, affecting up to 85% of amputees, but with limited positive solutions available. Previous systematic reviews of complementary therapies suggested the use of acupuncture and transcutaneous electrical nerve stimulation. However, there is a lack of randomized controlled trials and inadequate information to guide clinical practice and future definitive research. This narrative review aims to provide guidance for using acupuncture or \ TENS\ and to identify potential outcome measures and optimum treatment protocols for clinical practice and future research. Methods Case studies identified in a previous systematic review were included, with clinical characteristics extracted to provide narrative description. Results Thirty-six case studies (257 individuals) were included. Acupuncture usually involved body needling and was most frequently reported on the contralateral limb. Chinese papers tended to use body and scalp acupuncture together; studies reported in English language journals tended to use one style. Acupoints along Yang Ming meridians, Liv 3, and \ LI\ 4 were commonly used. Needle retention time varied but was usually 30–40 min. Most Chinese studies reported daily treatment for 10–30 sessions, English studies tended to treat less frequently (weekly) and provide a smaller number of treatments (4–7 treatments). Contralateral stimulation in the upper fifth and middle 2/5 of sensory area were frequently used to activate lower limbs and body with scalp acupuncture. \ TENS\ treatment tended to be administered at the stump, the contralateral side and in relation to dermatomal pain patterns and innervating peripheral nerves. High frequency \ TENS\ was the most frequently used treatment, usually administered more than once daily. Both acupuncture and \ TENS\ recorded positive outcomes. Visual analogue scales, numerical pain rating scales, pain rating indices and present pain intensity were common outcome measures. Conclusion Treatment protocols can be drawn from the case studies for clinical practice but information is variable. Differences in clinical practice between studies published in Chinese and English may be due to different educational background, qualifications, cultural expectations, and differences in healthcare systems and policy. Further studies are recommended to develop standard treatment protocols for further randomized controlled trials.
Phantom limb pain Phantom limb sensation Phantom limb syndrome Acupuncture Transcutaneous electric nerve stimulation Case study Clinical guidance
1876-3820
365-381
Hu, Xiao-Yang
65904b24-3775-4b14-9532-eb703a056655
Trevelyan, Esme
b6bccae7-54aa-4c93-8fbe-c35ad2cd9253
Yang, Guo-Yan
153c034b-50eb-4423-ad6b-013528d5c251
Lee, Myeong Soo
f9dae976-c57f-4eca-a700-a5d81a5b221c
Lorenc, Ava
7d3ba35f-0a60-4057-bd99-52c839870155
Liu, Jian-Ping
89fc77d6-dec2-431c-8f4a-5fb38f1986e8
Robinson, Nicola
5f60635e-978f-47fb-a7ef-3ef4499fcf1e
Hu, Xiao-Yang
65904b24-3775-4b14-9532-eb703a056655
Trevelyan, Esme
b6bccae7-54aa-4c93-8fbe-c35ad2cd9253
Yang, Guo-Yan
153c034b-50eb-4423-ad6b-013528d5c251
Lee, Myeong Soo
f9dae976-c57f-4eca-a700-a5d81a5b221c
Lorenc, Ava
7d3ba35f-0a60-4057-bd99-52c839870155
Liu, Jian-Ping
89fc77d6-dec2-431c-8f4a-5fb38f1986e8
Robinson, Nicola
5f60635e-978f-47fb-a7ef-3ef4499fcf1e

Hu, Xiao-Yang, Trevelyan, Esme, Yang, Guo-Yan, Lee, Myeong Soo, Lorenc, Ava, Liu, Jian-Ping and Robinson, Nicola (2014) The effectiveness of acupuncture or \ TENS\ for phantom limb syndrome. II: A narrative review of case studies. European Journal of Integrative Medicine, 6 (3), 365-381. (doi:10.1016/j.eujim.2014.02.001).

Record type: Article

Abstract

Introduction Phantom limb pain and phantom limb sensation are extremely prevalent, affecting up to 85% of amputees, but with limited positive solutions available. Previous systematic reviews of complementary therapies suggested the use of acupuncture and transcutaneous electrical nerve stimulation. However, there is a lack of randomized controlled trials and inadequate information to guide clinical practice and future definitive research. This narrative review aims to provide guidance for using acupuncture or \ TENS\ and to identify potential outcome measures and optimum treatment protocols for clinical practice and future research. Methods Case studies identified in a previous systematic review were included, with clinical characteristics extracted to provide narrative description. Results Thirty-six case studies (257 individuals) were included. Acupuncture usually involved body needling and was most frequently reported on the contralateral limb. Chinese papers tended to use body and scalp acupuncture together; studies reported in English language journals tended to use one style. Acupoints along Yang Ming meridians, Liv 3, and \ LI\ 4 were commonly used. Needle retention time varied but was usually 30–40 min. Most Chinese studies reported daily treatment for 10–30 sessions, English studies tended to treat less frequently (weekly) and provide a smaller number of treatments (4–7 treatments). Contralateral stimulation in the upper fifth and middle 2/5 of sensory area were frequently used to activate lower limbs and body with scalp acupuncture. \ TENS\ treatment tended to be administered at the stump, the contralateral side and in relation to dermatomal pain patterns and innervating peripheral nerves. High frequency \ TENS\ was the most frequently used treatment, usually administered more than once daily. Both acupuncture and \ TENS\ recorded positive outcomes. Visual analogue scales, numerical pain rating scales, pain rating indices and present pain intensity were common outcome measures. Conclusion Treatment protocols can be drawn from the case studies for clinical practice but information is variable. Differences in clinical practice between studies published in Chinese and English may be due to different educational background, qualifications, cultural expectations, and differences in healthcare systems and policy. Further studies are recommended to develop standard treatment protocols for further randomized controlled trials.

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More information

e-pub ahead of print date: 14 February 2014
Published date: June 2014
Keywords: Phantom limb pain Phantom limb sensation Phantom limb syndrome Acupuncture Transcutaneous electric nerve stimulation Case study Clinical guidance

Identifiers

Local EPrints ID: 413739
URI: https://eprints.soton.ac.uk/id/eprint/413739
ISSN: 1876-3820
PURE UUID: f16fc907-f656-45c0-9966-633af4f46bde
ORCID for Xiao-Yang Hu: ORCID iD orcid.org/0000-0002-3143-7999

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Date deposited: 01 Sep 2017 16:32
Last modified: 20 Jul 2019 00:33

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