Acupuncture For The Treatment Of Phantom Limb Syndrome

Abstract

Phantom limb syndrome (PLSd) is a prevalent complication post amputation which can be severe and chronic. Multi-disciplinary treatment is recommended, addressing peripheral, central and psychological factors. Although acupuncture is recommended, evidence supporting its effectiveness is sparse. This project aimed to develop an acupuncture protocol for the treatment of lower limb amputees with PLSd and evaluate its acceptability and feasibility prior to a definitive trial. The project was situated under the Medical Research Council’s framework for developing and evaluating complex interventions, and used a multiphase mixed methods research design. Three systematic literature reviews and two studies were undertaken to inform a feasibility study. The literature reviews aimed to identify previous research undertaken on the experience and management of PLSd. The first study, a Delphi study, aimed to develop an acupuncture protocol and the second, a qualitative descriptive study, explored amputees’ perceived acceptability of acupuncture within the context of living with PLSd. From these findings a feasibility study was designed and conducted, comprising a randomised controlled trial and semistructured interviews. The literature reviews identified limited qualitative studies exploring amputees’ experience of PLSd, limited evidence supporting interventions for PLSd and only two non-randomised controlled trials evaluating the effectiveness of acupuncture for treating PLSd. The Delphi study developed a novel acupuncture protocol which was considered ‘good practice’ and this was used in the feasibility study. The qualitative descriptive study produced rich data, not previously available on a UK demographic group of amputees shortly post amputation, on their experience of PLSd. PLSd was found to be ‘real’ and bothersome with effects on wellbeing. Additionally, acupuncture was perceived acceptable and outcome measures were identified for use in the feasibility study. The feasibility study generated new original findings on areas which would need addressing before undertaking a definitive trial, including; problems with recruitment, completion of outcomes at one month follow up, blinding, practitioner adherence to the acupuncture protocol, capture of rescue medication and recording of adverse events. Acupuncture was perceived to be effective at resolving or reducing PLSd. Findings from this project could inform the development of a definitive trial to establish the effectiveness of acupuncture for treating PLSd.