April is Limb loss awareness month! People who have lost a limb are likely already quite familiar with Physical and Occupational Therapy services, and there is a fairly standard therapy treatment protocol for these clients. However, one area that often comes up and can leave some clinicians scratching their heads….is treating phantom limb pain.
Mirror therapy is a fairly standardized and well-supported intervention for the treatment of phantom limb pain in therapy, as well as early prosthetic training and the use of a shrinker. Yet, Phantom Limb Pain remains a consistent complaint among those who have suffered limb loss, and the therapists who treat them! Here, we take a look at a few of the less often used and more unconventional therapeutic approaches to phantom limb pain: such as Neuromuscular Taping, Vibration, and Vibration/Electrical stimulation combined).
- Neuromuscular taping (NMT): Taping is something we use for a million different indications in therapy! But there is some interesting research to suggest it may be helpful in treating phantom limb pain. This 2017 study compared two groups of individuals who had undergone lower limb amputation and were experiencing phantom pain syndrome. One group received neuromuscular taping and conventional physiotherapy, and the second group received conventional physiotherapy alone. The results showed that conventional physiotherapy IS effective in reducing phantom pain in post amputation subjects, but when combined with neuromuscular taping, treatment becomes very effective. Using the Visual Analog Scale for pain, those who were in the experimental group (taping + therapy) had results in 6-7 treatment sessions, compared to 8-10 treatment session for control group.
NMT may be aiding in pain relief by providing sensation input to the central nervous system, informing the Gate Control and Biofeedback Models of Sensory Integration. Studies on the mechanism of taping for Myofascial pain also hypothesize that it may reduce pain through facilitation of circulation, which (1) will remove inflammatory substances (2) remove inflammatory heat and (3) decrease pressure on the nociceptors.
Considering how low cost, low risk and non-invasive Neuromuscular Taping is, it makes perfect sense to include in your sessions!
- Vibration: Using vibration can again harness the sensory stimulation mechanism as discussed and provide input to a person’s residual limb. Yet, this particular modality has not gotten much research in the past few decades- studies have seemed to focus more on modalities such as TENS and mirror therapy. Is vibration as a therapeutic approach less effective, or can it be a useful tool to use in treating phantom limb pain?
Vibration can help with pain management through peripheral nerve stimulation, activating large sensory nerve fibers. This can work on the Gating Pain mechanism, and also help to relax the limb. Vibration can be a good option to include if your patient has a contraindication to the use of other modalities, or any cognitive impairment that might make you hesitate around using Mirror Therapy or electrical stim. Vibration might also be more convenient as it can be portable, worn at night, and is low-risk. Take a look at some extremely interesting devices that incorporate vibration for pain relief and gait!
If a portable, convenient solution is what you think your client with PLP is looking for: A vibration device may be a good option.
- Vibration combined with Electrical Stimulation: Electric Stimulation, most commonly in the form of TENS (Transcutaneous Electrical Nerve Stimulation) is a commonly used therapeutic modality for chronic pain and phantom limb pain post-amputation. This is also an easy to use, non-invasive modality, and is well supported in the literature. However, combining the use of TENS and Vibration therapy has evidence to show that it can an even more effective approach. This research article examining Vibration and TENS applied both separately and simultaneously, showed that simultaneous application not only reduced pain in more cases that either modality used separately, but also had longer lasting and stronger effects!
If your patient is suffering with Phantom Limb Pain, and you have TENS and vibration resources, it would be well worth it to try to combine these resources for a more effective, longer-lasting result!
These are a few of the more unconventional therapeutic treatments options that you could possibly incorporate into your plan of care. Have you tried any of the above? What were your outcomes? Drop us a line in the comments below??!