831 - Dramatic Relief in Phantom Limb Pain Following Chinese Scalp Acupuncture

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

OJ

Oranicha Jumreornvong, MD

Resident Physician
Icahn School of Medicine at Mount Sinai
New York, New York, United States

Co-Author(s)

Bd

Bogan davidescu, MD

Attending Physician
James J. Peters Department of Veterans Affairs Medical Center
New York, New York, United States

Case Diagnosis: Phantom Limb Pain

Case Description: In this case report, a 60 year old male with bilateral below knee amputations presented with phantom limb pain. Patient has previously failed conservative treatment with optimizing gabapentin, duloxetine, lidocaine patch, physical therapy, and occupational therapy for 20 years. His pain persisted for seconds and repeated every five minutes for a few hours to days, affecting his sleep and overall quality of life. Initially, he rated his pain a 10 on Visual Analogy Scale (VAS) and quality as “sharp” and “electric.” Immediately post CSA treatment with electrical stimulation, he reported pain to be a 0. After 2 months and 4 months intervals, he reported his pain to be a 1, and that the CSA controlled his pain at the level of a 0 or 1 post treatment. Patient receives chinese scalp acupuncture biweekly to prevent his phantom limb pain episodes.

Discussions: Up to 80% of amputees report phantom limb pain (PLP), the management of which remains a considerable challenge. Although pharmacological treatments such as barbiturates, muscle relaxants, antidepressants, neuroleptic agents and anticonvulsants have been recommended, their wide range of side effects is a cause for concern. Few studies have explored the clinical effect of

acupuncture in PLP. Chinese scalp acupuncture (CSA) integrates a neurophysiologic understanding of the sensory motor cortex and traditional acupuncture methods. Research shows that neuroplastic changes of the sensorimotor cortex are often associated with PLP. This highlights the use of motor and parietal cortex stimulation in the treatment of PLP.

Conclusions: This case report identifies an example of successful implementation of CSA as a minimally invasive adjunct treatment for phantom limb pain, resulting in significant pain reduction and avoidance of opioid medications, warranting further study with larger samples and randomized control trials to better understand the role it should play in multimodal regimens.