Pain Control

I have a new patient coming in who has Phantom Limb Pain.  She has had multiple attempts at Western pain control techniques with some success, but she has reached a plateau.  This will be her first acupuncture experience.  Does anyone have experience with successful treatment of these patients, and are there any particular points or techniques you would recommend?  Thanks for your consideration.


Comments

Chad Dupuis's picture

There are a host of

There are a host of techniques for phantom limb pain involving any combination of scalp acupuncture, body acupuncture and/or auricular points.  The general idea is to resolve the issues within the sensory cortex of the brain to eliminate/lessen the messages from the brain to the non existent limb.  Treatment will of course vary slightly from patient to patient based on their underlying symptoms (i.e. their TCM diagnosis) and the limb(s) affected as the anxiety aspect of whatever caused the loss of limb is important and has systemic effects.

Within the Tam Healing System that we largely utilize the most important of all of these points is GV 19 which we use to effect the sensory cortex and GV 20 for the motor cortex.  The other points are generally points which resolve qi stagnation and calm the mind - so LI 4, LV 3, PC 6, HT 5, SP 10, Shen Men.  Then you can work with needling corresponding points on either the same side arm as the missing leg or on the opposite leg or both.  It really is most important to treat the patients underlying pattern so I can be more specific when you have seen the person and have more signs to discuss.

Simon Light's picture

I haven't treated anyone for

I haven't treated anyone for phantom limb, but I have worked with a dozen or so amputees for other things.  Feng Mei actually raised a good point.  Something that needs to be clarified is where the pain is coming from.  The surgeons I have spoken to and the people with whom I have worked have said more or less the same thing:

1.  There is pain that actually comes from the amputation site, but because of the damage to nervous system and the strangeness of the situation for the brain, it feels and seems as if the pain from the amputaion site affects the limb, even though it's not there any more. 

2. The missing limb feels as if it's still there, but there is no pain.  The person might still feel to be able to grab things with their hand, or curl their toes et c.  This is the basic phantom limb phenomenon without the complication of pain.

3. The phantom limb itself is in pain, and this pain might not have anything to do with the amputation site.  This is a whole other kettle of fish.

Most people actually fall into one or all of these categories at some stage, and treatment seems to have been gauged in accordance with their experience.  So, for example, Feng Mei's suggestion might work well with people in No.1, but less well for people in No.3.

I dug out some lecture notes I stole from a friend and here is what it says:

"For phantom limb syndrome, use biao-li [method].  Look for ahsi points along the yin-yang related channel on the opposite leg, and needle them for 30-40 minutes.  Example: right leg amputated, Stomach meridian.  Look for ahshi points along whole of Spleen meridian of left leg.  Needle at first the most painful point/points."

Since all the meridians are affected, what this basically boils down to is that you have to palpate all six meridians of the other leg looking for ahsi points, whether they be above or below the level of the amputation site on the affected leg.  Like I said,  I have no direct experience of this treatment, so I have no idea if it works.  I do however have experience with the system whence I filched the lecture notes, and as a system, it's quite good.  (Unlike my shampoo, I have recommended it to friends.)

Another consideration that I they told me is that the kind of pain in No.3 changes, or can be helped more effectively, if the person has reached the point in their life that they no longer dream of themselves as being having that limb.  They appear in their dreams as amputees.

One last thing: many people like those described in No.3 would not necessarily like to loose the sensation or feeling or experience of the phantom limb, if only they could get rid of the pain.

Feng Mei's picture

For the phantom limb pain,

For the phantom limb pain, that mean even the above knee been amputated, but the Qi still on the Leg area, it like a radiac energy field as a leg shape, so the Qi is in there, but the blood can not go to there, so the blood will staganate in above knee, that is why she feel phantom limb pain, for treat the phantom limb pain, first thing is calm down mind, the most important point is "YinTang", then Lv3 (on the other leg), and Li4, Ren4, Ren6, Ren 17, Sp6(the other leg), Sp10(the other leg), etc.. 

tdheiman's picture

Follow-up on First Visit

[...removed by moderator...] I treated her with bilateral auricular Shen Men, and LV 3, SP 6, ST 37, ST 36, ST 32.  She really seemed to have a response in sensation in her phantom limb with points LV3 and ST 32.  After the treatment she was amazed that she felt like she could contract her phantom calf muscle and move those toes.  A sensation she has never had before.  Thanks to all of you for your responses, and hopefully you can give some additional suggestions, or critiques.  I will definitely add Yin Tang, GV 19 and GV 20 as per your recommendations.  Thanks again.

Simon Light's picture

Hi! I read your folow-up to

Hi!

I read your folow-up to a friend who lost four fingers of her left hand when she was a kid.  She said she'd love to be able to bend her fingers again like your lady did with her calf, and that you did was a wonderful gift for your client.  She described how for years after her accident, she could feel and bend her fingers quite clearly and distinctly, but for some reason, over time, the sensation, though still strong, became less defined.  She said she felt her fingers like frozen Findus fish fingers.  I asked if she would like to try acupuncture.  She waved her empty hand at me.  She said she was flipping me a fish finger.

What was your choice of points based on?

Lorinda Morimoto's picture

treating phantom limb pain

I am helping an elderly (87) woman who leg was amputated at the hip because of cancer.  This happened 30 years ago and she has been experiencing increased shooting nerve pain from the hip to her toes in the phantom leg.  She has been taking strong pain medication which she began to worry about because of addiction.  The shooting pain stopped after the first treatment.  What I tried was:  Sympathetic, Shen Men, and Hip ear points in the ear opposite to the amputation; an ion cord treatment using L Kid. 6- to R Lu7+ and L TW 5- to L GB 41+.  I used this combination because she was also experiencing gastrointestinal distress.  During the next visit I used GV 19 and scalp points for lower limbs along with LI 4 , Sp 6, and GB 34.  I was trying to think in terms of her whole being and what imbalances seemed to be occurring.  Hope this is helpful.