Phantom Limbs and Acupuncture

anonstudent01's picture

Phantom Limbs and Acupuncture

Two years ago while in Singapore my friend and I thought it would be interesting to have our health evaluated by an Eastern medical practitioner. It was a wholly different experience from my yearly visit to the General Practitioner in St. Paul, Minnesota. The doctor determined that I needed to eat a greater variety of spices, drink more hot fluids, and could relate my almost complete medical history without any previous information. After the evaluation and recommended acupuncture treatment I was surprised to discover that my shoulder pain was alleviated by a needle placed in the bottom of my foot while the needles in my forehead rid my lower back of stiffness. The acupuncturist explained that over 2,000 corresponding locations (meridians) are mapped out on the body for manipulation to unblock energy and alleviate stress, compression and pain. After our class discussion regarding phantom limb pain- that is abnormal sensation perceived from a previously amputated limb (2) - I was interested to explore whether or not my experience could be duplicated for those with phantom pain. To do this we must establish some understanding of the nature of phantom pain as well as the application of acupuncture to alleviate discomfort by engaging sensory receptors at meridians elsewhere on the body.

I began by looking for research regarding the treatment in eastern or alternative medicine for perceived pain in phantom limbs as opposed to traditional Western medication. Surprisingly, several cases have been documented and studies have observed that acupuncture can in fact work to ease such pain (1). It is essential to gain an understanding of the reality of pain in concurrence with the nervous system. The example of phantom limb pain invalidates the “labeled line” theory, which states that physical pain is the result of a direct line of responses which begin with the stimulation of receptors in the skin that are sensitive to painful stimuli. If this were true then when a limb is lost the patient shouldn’t experience pain because those receptors in the skin are now gone and cannot carry the pain signal to corresponding axons and eventually to the brain (making treatment or even diagnosis an impossibility). Because patients do experience pain in their phantom limbs then there must be another explanation for this pain as well as an explanation for how it can be physically alleviated when the limb is no longer there.

In class we learned that the sensation of phantom limb pain is actually the result of the nervous system acknowledging an internal inconsistency. Sensory input from the missing limb and the corollary discharge signals are not aligned because the loss of a limb means a loss of sensory input from the limb but not the corollary discharge signals. From the point of view of the nervous system it is still receiving information from the missing limb, and the pain experienced by the patient can be interpreted as a response from the nervous system to the mismatch between corollary discharge signals and sensory input. According to an acupuncture information database, “there is a reorganization of the primary sensory cortex, subcortex and thalamus after amputation. The reorganization of the sensory cortex currently is considered to be responsible for phantom limb pain (2).” This means that in order to alleviate phantom limb pain acupuncture needs to engage the nervous system to override the response to mismatched information. Though the sensory receptors in the skin that are sensitive to pain stimuli can not be replaced, if receptors are intact and engaged on the corresponding meridian then perhaps the nervous system will no longer interpret that something is very wrong.

The National Institutes of Health has found that acupuncture can be an effective treatment for some types of chronic pain. In acupuncture, the practitioner inserts sterilized stainless steel needles into the skin at specific points on the body. It is thought that acupuncture stimulates your central nervous system to release neurotransmitters, hormones or the body's natural pain-relieving endorphins. Acupuncture may also alter how your blood pressure, blood flow and body temperature are regulated and respond to pain (3).” This information offers the traditional Western medical interpretation of how acupuncture actually works in relation to the nervous system, which is more technical than the Eastern interpretation (recharging the vital flow of energy or qi). If this interpretation is less wrong, indicating that phantom pain is resultant of a mismatch in information sent to the nervous system and acupuncture stimulates the central nervous system to release neurotransmitters, then the connectivity of the meridians must indicate the direct relation of neuronal communication at physically distant locations across the body.

This combined information is neither an answer nor a prescription; however it expands our possible understanding of our nervous system’s utility of pain in addition to a possible treatment for those who experience pain which can not be physically identified. Western medicine is progressing beyond the separation of mind and body and hopefully will employ Eastern practices and ideology to address a holistic human entity that is entirely interconnected. When this is realized, more people will find relief without ingesting medication or cutting out a part of their body- hopefully without needing a plane ticket to South East Asia.

Sources:

 

  1. An Introduction to Acupuncture. National Center for Complementary and Alternative Medicine: National Institutes of Health. December 2007. http://nccam.nih.gov/health/acupuncture/

 

  1. Hao, Jason Jishun, DOM, MTCM, MBA and Hao, Linda Lingzhi, DOM, PhD. The Treatment of Phantom Pain by Scalp Acupuncture. AcupunctureToday.com. 2006. http://www.acupuncturetoday.com/mpacms/at/article.php?id=30431

 

 

  1. Phantom Pain. CNN Health Library. 1998-2008 Mayo Foundation for Medical Education and Research (MFMER). http://www.cnn.com/HEALTH/library/DS/00444.html

 

Comments

Carol D.'s picture

Acupuncture or Acupressure?

In 2007, two separate amputations were performed on my left leg.... the first at my calf and later after developing a staph infection, halfway up my thigh. For a year now I have suffered with horrible phantom pain in my left "foot". A pain specialist prescribed Neurontin in extremely high doses which helped tremendously but obviously I haven't wanted to stay on such a high maintenance dose.

I have been seeking other methods of treatment such as acupuncture and acupressure but I don't have enough knowledge (other than the excellent article above) about which is the better treatment in my situation. If anyone who reads this can refer me to more in-depth studies regarding treatment(s) for this (genuine, not perceived)problem, I would be so grateful. Thank you. Carol

keerthi kris's picture

This was exactly what Dr

This was exactly what Dr Ramachandran talked about. In the penfield's homunculus, the regions for the limb are very close to that of the face. So when a person with itch in the phantom arm is stroked on the face the itch disappears. This explains the reorganization of the sensory cortex after amputation. Employing acupuncture in treating phantom limbs is interesting too.

Paul Grobstein's picture

acupuncture and pain: a new direction?

Its a very interesting idea that acupuncture might work by altering a "something wrong" conclusion in the nervous system, worth exploring further. Yes, we talked in class about pain as "internal inconsistency". For the record, though, it should be noted that that is not at the moment the consensus understanding of pain (see Pain: nocipeption or something more? and other perspectives posted in that forum). Perhaps your link to accupuncture will contribute to a change in understanding.

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