針炙對截肢幻痛治療之初步探討

Therapeutic Trial of Acupunture in Phantom Pain of Amputees

廖美雲(Mei-Yun Liaw) ； 黃美涓(May-Kuen Wong)

《中華民國復健醫學會雜誌》 19期 (1991/12) Pp. 61-70

https://doi.org/10.6315/JRMA.199112.0061

摘要

本研究以1985 Carabelli於截肢側相應部位應用TENS減輕幻痛的經驗及中醫針炙取穴理論，在幻肢對側或同一上下肢體相應，附近穴道實行針刺，療程1至4次不等，留針時間約為30分鐘。以針刺前疼痛度為10分，評估針刺對幻痛止效果。共13例，均為男性。上肢截肢者5人，下肢截肢者8人，萁中有一為雙下肢截肢。共分3組，幻痛發生後一週內即接受針炙治療者為急性組有7人，第2週者為亞急性組有4人，第3週至半年內為慢性組有2人。結果顯示：針對急、亞急、慢性幻肢痛大多能暫時有效地減輕疼痛，以第一次針刺效果最好，能減輕一半以上的疼痛，且有逐次減輕幻痛的現象。

關鍵字

截肢 ； 幻肢痛 ； 針刺治療 ； 復健

並列摘要

The treatments of phantom limb pain(PLP)by many different modalities are based on the theoretically proposed mechanisms and clinical experiences. Scientific evaluation of the therapeutic effect in phantom pain is not very easy to be done.
To investigate the effectiveness of acupunture in PLD. 13 male amputees were studied, with mean age of 34.8 ±17.0 years. All subjects had suffered from severe phantom pain. Amputation of upper and lower limb were involved in 5 and 8 patients respectively, with one involved bilateral high above knee amputations.
They were divided into 3 groups based on the time of receipt of acupunture therapy after the onset of PLP. The acute group (7 patients ) received acupunture within one week after onset of PLP. while the subacute group (4 patients) was at the second week. and the chronic group (2 pa-tients) was in between the third week and six months after the onset of PLP.
Acupunture therapy was applied to the acupoints of the countralateral, sound limb at the same level as the locations of phantom pain mostly, or at the either residual intact upper extremities of the amputations side in that patient with bilateral lower limb amputations. The de qi reponse at the acupoint after inserting the needle was defined by presence of soreness, numbness, warmth. heaviness and distended feeling. Each needle should remain in situ for 30 minutes after de qi response. All patients received acupunture therapy for about one to four times. Each patient was asked to evaluate his pain intensity by the verbal score(10-0). All subjects had significant improvement in the decrease of PLP after acupunture, especially at the first time of treatment. The verbal scores after the first acupunture therapy and after full course treatment were 2.50 ±2.77 and 2.07 ±1.69, 4.25±1.71 and 2.00±1.32. 4.75 ±0.35 and 3.50±1.41 in acute, subacute and chronic group respectively. The result might suggest that cupuntrue would produce immediate analgesic effect or even long-lasting relief of phantom pain. both in reduction of the duration as well as the frequency of PLP. The tightness and clenched fist in phantom limb might also be relieved by acupuncture therapy gradually.