The effectiveness of acupuncture/TENS for phantom limb syndrome. I: A systematic review of controlled clinical trials

IntroductionPhantom limb pain (PLP)/phantom limb sensation (PLS) is common in amputees and difficult to treat but either acupuncture or transcutaneous electrical nerve stimulation (TENS) may provide relief. A systematic review of controlled studies was carried out to explore clinical effectiveness, cost-effectiveness and adverse effects of these treatments on PLP/PLS.MethodLiterature searches were carried out using 18 databases (inception - February 2013). Reporting quality and risk of bias of controlled studies were assessed by independent reviewers.ResultsIn two controlled studies, acupuncture significantly improved pain compared with usual care (visual analogue scale 0.17 ± 0.804 vs. 1.82 ± 1.919, p < 0.05; visual rating scale 1.45 ± 1.52 vs. 1.81 ± 2.22, p: not reported); two studies using TENS showed significant improvement in pain compared with sham TENS (pain rating index total F(1.31) = 7.48, p < 0.01; pain complain 0/12 vs. 7/12). One study showed better pain relief with TENS stimulation at stumps than stimulation on contralateral side. The reporting quality and methodological quality of controlled studies are critically discussed.ConclusionThere is some evidence for the use of acupuncture and TENS for the treatment of PLP/PLS but insufficient high quality evidence is available. No studies evaluated cost effectiveness or adverse effects.