Esmé Trevelyan

Developing an acupuncture protocol for treating phantom limb pain: a Delphi consensus study

Background Little is known about how a Traditional Chinese Medicine (TCM) approach could be used to treat phantom limb pain (PLP). There is currently no standard acupuncture protocol in the literature to treat this syndrome. Objectives To achieve consensus among a group of acupuncture practitioners on the pathology and recommended treatment of PLP and devise an acupuncture protocol for the treatment of this condition. Methods A classical Delphi approach was used using two parallel online Delphi studies. One study focused on participants with past experience of treating PLP (TPLP, n=7) and the other on practitioners with no past experience (NTPLP, n=16). Two hypothetical case studies were provided and participants were asked for responses on how they would treat these patients. Three rounds were included. Participants were also invited to rate and comment on the finalised protocol. Round 1 data were analysed using content analysis. In subsequent rounds an a priori criterion for defining consensus was set at ≤1.75 IQR. A group median of 5–6 was considered to mean ‘agree’. Results 19 participants completed all Delphi rounds (12 NTPLP, 7 TPLP). 108 NTPLP and 76 TPLP statements were generated and circulated in round 2; 53% of the NTPLP statements and 62% of the TPLP statements met consensus in round 2 and 45% of the NTPLP statements and 44% of the TPLP statements met consensus in round 3. Participants all agreed with the final protocol developed. Conclusions The protocol developed does not claim to be best practice but provides a preliminary consensus from practitioners practising acupuncture for the treatment of PLP.

Perceptions of phantom limb pain in lower limb amputees and its effect on quality of life: a qualitative study

Background: Phantom limb pain (PLP) is a prevalent complication post-amputation. Currently, qualitative literature exploring the experience of PLP in amputees is sparse, and little is known about whether the educational needs of amputees are being met. Objectives: To explore lower limb amputees’ descriptive lived experiences of PLP, to understand how PLP affects quality of life and to determine whether amputees feel they are provided with adequate information about PLP. Methods: A qualitative descriptive approach, situated under the constructivist paradigm was taken, consisting of cross-sectional semi-structured interviews. A purposive sample of 15 lower limb amputees, 1–3 months post-surgery with past or current experience of PLP were interviewed once about their experience of PLP. Interviews were audio-recorded, transcribed verbatim and analysed using Framework Analysis. Interviews were conducted while participants were inpatients at an amputee rehabilitation unit in London. Results: Six key themes were identified during analysis, of which three were related to PLP and are reported on in this article (real and physical phantoms, living with a phantom and being informed). PLP had numerous painful qualities. The phantom felt real, with kinetic and kinaesthetic properties. PLP had multiple meanings to amputees, was considered a reminder of circumstances and could affect quality of life. Information provided about PLP was inadequate. Conclusion: PLP can be a severe and annoying experience acting as a reminder of amputees’ circumstances. Information provided about PLP is inadequate, with some amputees still perceiving PLP as mental and imaginary. Education about PLP and awareness and accessibility to non-pharmacological interventions needs to be improved.

Exploring the experience of phantom limb syndrome and acceptability of acupuncture intervention to lower limb amputees

Purpose: Phantom limb syndrome (PLSd) is a frequent chronic complication post amputation and is difficult to manage with conventional medicine. Acupuncture has been shown to be effective in the management of other chronic pain conditions but little is known about the effectiveness of acupuncture for themanagement of PLSd. The study is nested in a larger study evaluating the feasibility of acupuncture for treating PLSd and aimed to explore the experience of PLSd and establish the acceptability of acupuncture intervention to treat PLSd. Methods: Study design comprised of a case study approach using multiple cases. One off semi-structured interviews were conducted with a purposive sample of 15 lower limb amputees 1-3months post-surgery, with past or current experience of PLSd. Interviews explored participants’ experience of PLSd and perceived acceptability of acupuncture intervention. Framework analysis was used to analyse data. Results: 6 key themes were identified during analysis; suffering (prior to amputation), acceptance and coping with the loss of a limb, real and physical phantoms, living with a phantom, being informed about PLSd, acupuncture acceptability. Additionally, outcome measures for the feasibility study were substantiated for ease of completion and relevance. Acupuncture was generally considered an acceptable intervention regardless of positive or negative past experience and few concerns were expressed. Local needling of the residual limb was considered acceptable. PLSd was perceived as a real and physical pain and participants used numerous and often metaphorical descriptions. PLSd frequently disrupted sleep and negatively affected wellbeing and mood. Conclusion: The study contributes to existing evidence exploring the experience of PLSd and identified that PLSd is a bothersome and annoying condition which affects quality of life. Findings suggest that amputees suffering from PLSd would be willing to try a complementary medicine (acupuncture) approach to help manage this condition. Contact: Esme Trevelyan, trevelye@lsbu.ac.uk / Nicola Robinson, nicky.robinson@lsbu.ac.uk