Phantom Limb Pain (PLP)
For many years Holly has seen that the most common and obstructive issue to successful amputee rehabilitation, is pain and particularly PLP. Those suffering, also often struggle with exhaustion, loss of concentration, and depending on the severity, it can severely delay or halt an amputee’s recovery and rehabilitation. Clinical experience made her acutely aware of the detrimental side effects from use of prescription medication.
With post-graduate training in western medical acupuncture and a background in musculoskeletal physiotherapy, Holly looked to find a non-pharmacological management strategy.
Acknowledging that some external factors may exacerbate an amputee’s PLP, Holly recognised that there were significant biomechanical changes that took place locally at the severed nerves, post amputation.
She explored dry needling in the lumbar paraspinals between L1-L5 and in the residual limb (landmarks on the photographs - PSIS and bottom of ribs for your reference.)
Unfortunately, she found that the outcome was marginal and any reduction in pain was very short-lived.
So, Holly went on to explore applying electroacupuncture (EA) to the same points to increase the intensity and effect and discovered a much greater and longer lasting relief from PLP.
In her recently published paper, she has taken one case study from her clinical practice to highlight the positive outcomes of EA, but she has many more successful cases.
The case study is of a patient 7months post-traumatic high transfemoral amputation, with severe and uncontrolled PLP, that consumed all parts of his recovery and disturbed his sleep. He had minimal relief and significant side effects from pharmacological medication and had tried graded motor imagery, education, and sleep strategies with minimal benefit.
After 3months of weekly EA and then periodic 4-5weekly top ups, he had a significant reduction in his PLP severity, frequency, and duration (as demonstrated on the downward trajectory on the graph).
He was able to stop taking his pain medication and was able, to sleep 7-8hours a night, whereas previously he only managed a couple of hours a night. His prosthetic use and function also significantly improved from a few hours a day to full-time.
At 12 a month review he only had mild PLP occurring less than once a week.
Holly’s paper proposes that neuropathic PLP chronicity may be prevented by eliminating the peripheral nociceptive stimuli using EA.
Evidence is growing that there is a positive correlation with high dose acupuncture and positive outcomes. Since this case study, Holly has increased the time of each EA treatment to 60 minutes and increased the intensity which has given even better results.
This case report is important as it shows for the first time that an easily reproducible EA protocol is effective in reducing PLP in amputees.
We hope that EA will be taken up by other healthcare professionals as a simple and very effective treatment for PLP.
If you are interested in exploring this further, we’d love to hear from you. Please email us at info@hkphysioltd.co.uk
Holly presented her paper at the 1st International Conference of Phantom Limb Pain 31 August – 2 September 2021. Click the button to view more about the conference.
