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

IntroductionPhantom 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.MethodsCase studies identified in a previous systematic review were included, with clinical characteristics extracted to provide narrative description.ResultsThirty-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.ConclusionTreatment 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.