Wednesday, June 19, 2013

Treatment of Phantom Limb Pain with Traditional Chinese Medicine

Phantom limb pain (PLP) is a condition that includes a variety of symptoms including tingling, itching, burning and aching in an amputated limb.  Three prominent explanations for PLP are maladaptive changes in the primary sensory cortex after amputation, a conflict between signals from the amputated limb and visual signals for motor commands to the missing limb and limb position memories that emerge after amputation.

Traditional Chinese Medicine is a broad range of medical practices sharing common concepts which have been developed in China and are based on a tradition of more than 5,000 years, including various forms of herbal medicine, acupuncture, massage (Tui na), exercise (qigong), and dietary therapy.

In any extremity, there are long sensory nerves and nerve bundles that go between the sensory receptor site, perhaps at a finger or toe, all the way to the spinal cord. There are various types of nerve fibers which carry different types of sensory information. Some type are insulated with a covering like insulation around a wire, while others have no insulation. The nerves without insulation are very sensitive to different chemicals that are naturally found in different types of tissue.

After an amputation, what remains of the long nerves can sprout new sensory endings as the residual limb heals. It is likely that the uninsulated nerves will manage to sprout new sensory endings into tissue where they were not intended to be; the most likely tissue being scar tissue. Experts in pain theory hypothesize that these nerve fibers which grow into the wrong tissue type, may relay “false “ pain signals, because they are so sensitive to the change in chemicals around them.

The presence of phantom sensations is related to how the brain remaps itself following an amputation. This process begins remarkably soon after amputation. Each area of the sensory cortex in the brain is dedicated to a given area of the body, but the brain does not deal with a void of information well, so, when a body part is amputated, the area of the sensory cortex that was once dedicated to the area removed starts to receive information from areas of the body that have adjacent representation in the sensory cortex.

In an example of an amputated hand, the area of the sensory cortex dedicated to the hand has representation for the arm above it and representation for the face below it. In this case the individual who's hand was amputated may experience sensation in the amputated hand when the forearm, face or both are stroked. Also, since there is a variety of constant sensory information that comes from receptors in the skin, joints, and muscles, it is possible to feel the missing hand whenever the individual moves the forearm, speaks, or smiles.

What causes pain in Traditional Chinese Medicine is “qi and blood stagnation” which means something has obstructed to smooth flow of qi and/or blood and it is building up behind the obstruction, which results in pain. The job of the practitioner is to determine what is contributing to the obstruction then use needling or other modalities to help restore the proper flow of qi and blood.
In the case of amputation, the primary cause is trauma, even if done surgically. Where the meridians once connected is now severed, and the qi cannot flow along its normal pathways. Visible evidence of qi and blood stagnation can manifest as swelling, redness, or purple areas near the pain. Sometimes there are no outward signs on the injured area, but the patient will often have a purple-ish tongue body.
Because of the sensitivity of the area from where the pain seems to emanate, it may often be best to needle in an area distant to the actual area of injury. Meridian theory supports using related meridians along analogous parts of the body. For example, if there is pain in the knee, treat a related meridian in the elbow, often on the opposite side. 

Two areas to look at in the cause and treatment of phantom limb pain following amputation are the site of amputation, and the area of the brain where sensory information from the amputated area is located.

Important Acupuncture/Acupressure Points for the treatment of PLP:

DU 20
GB 21
GV 19
GV 20
LV 3
PC 6
HT 5
REN 17
SP 6
SP 10
ST 32
ST 36
ST 37

Interesting Case Study:

1 comment:

REBECCA jones said...

Indeed it’s true that Phantom Limb pain is one of factors responsible for musculoskeletal disorder. A local Mississauga chiro clinic is providing medication less and natural treatment for these kind of musculoskeletal disorders. Will advise everyone to visit there once.