Phantom Limb Syndrome
Phantom Limb Pain and Reflexology Research
by Barbara & Kevin Kunz
For amputees experiencing phantom limb pain, a 30-week study found that reflexology work made a highly significant difference and was “effective in eradicating or reducing the intensity and duration of phantom limb pain.”
Seven men and 3 women “with unilateral lower limb amputations and a history of phantom limb pain” followed a five phase program. They kept a weekly pain diary in addition to under-going: a six week period of a base line of pain diary keeping; six weekly reflexology session; a six-week rest phase; a six week teaching phase and a six-week self help (hand reflexology) phase.
Positive results followed the reflexology session, teaching and self-help phases. Brown C, Lido C, “Reflexology: A treatment plan for phantom limb pain?” Physiotherapy 2007;93(S1):S185
The pilot study was conducted by physiotherapist and reflexologist Tina Brown at Prosthetic Services Centre, Wolverhampton City NHS Trust, Wolverhampton, England. In the publication Step Forward (4/4/2007) she notes:” I did this project out of pure interest, but I am now enquiring at the local University about a full study being linked to some sort of further education … “Although I do not think that reflexology is the answer to everyone’s PLP (Phantom Limb Pain), I do feel that it is a pleasant, non-invasive therapy that does help in some situations. Another benefit found was that the patients could self-treat after being taught how to use reflexology on their hands. … I would love to see if it helped pre-amputation: i.e. would it help prevent PLP from occurring?”
Phantom Limb Pain
Purpose: The main objective was to test if reflexology could be used as a non-invasive form of phantom limb pain relief. The second objective was to test the possibility that patients might be able to achieve any positive results with self-treatment.
Relevance: Management of phantom limb pain has always been a part of the physiotherapists role and whilst there have been single case studies by physiotherapists into using reflexology to treat this phenomenon, the author could not find any larger research studies. It was felt that more research is needed in this area in order to build the evidence base required for this method of phantom limb pain relief.
Participants: There were 7 men and 3 women with unilateral lower limb amputations, varying from below knee to hind quarter levels, and a history of phantom limb pain. Aetiologies were osteomyelitis, trauma, diabetic gangrene, ulceration, thigh tumour and necrotizing fasciitis. The mean age was 62.5 years.
Methods: Same-subject, experimental pilot study; recording pain in weekly pain diaries during a 30-week period. Phase 1 six weekly diaries for base line of pain. Phase 2 six weekly diaries and six weekly reflexology treatments. Phase 3 six weekly diaries only, resting phase. Phase 4 six weekly diaries and six weekly teaching sessions. Phase 5 six weekly diaries and self treatment. Analysis: A numerical rating pain scale; 0 = no pain, 1 = mild pain, 2 = moderate pain, 3 = severe pain, an ordinal duration rating scale; 0 = not applicable, 1 = once a week, 2 = a few days a week, 3 = once a day, 4 = more than this, and a numerical lifestyle scale; 0 = not applicable, 1 = does not interfere, 2 = slight interference, 3 = moderate interference, 4 = interferes a lot, 5 = completely interferes were used in the diaries. These scales were sanctioned by a clinical specialist in pain management. The statistician entered the data into the Statistical Package for the Social Sciences (SPSS), it was analyzed using both parametric and non-parametric tests, there was no difference between the results of these and therefore, parametric tests were reported (ANOVA & LSD). Effect sizes analysis was also carried out in order to account for the small sample.
Results: Repeated measures ANOVA for average reported pain revealed a highly significant ‘overall’ difference, whereby the treatment phase does makes a difference to pain; F(4,28)=4.38, p=.007. This indicates that the probability of finding this pattern due to chance is less than 1%. The same test was used for the analysis of duration and affect on lifestyle; F(4,36)=4.98, p=.003 and F(4,36)=3.57, p=.01
Conclusions: The project indicated that reflexology treatment, teaching and self-treatment were effective in eradicating or reducing the intensity and duration of phantom limb pain in this group of patients. IMPLICATIONS: Physical therapists could play a pivotal role in the treatment of this phenomenon by using reflexology. Brown C, Lido C, “Reflexology: A treatment plan for phantom limb pain?” Physiotherapy 2007;93(S1):S185 Prosthetic Services Centre, Wolverhampton City NHS Trust, Wolverhampton, England. 2 Thames Valley University, London
Funding Acknowledgements: Wolverhampton City NHS Primary Care Trust, c/o Research & Development Department, The Beeches, Penn Hospital, Wolverhampton, West Midlands, England. CONTACT: firstname.lastname@example.org
Ethics Committee: Wolverhampton District Local Research Ethics Committee; REC reference number: 04/Q2701/31; Approved: 11th February 2005; Completed December 2005