Phantom Limb Pain and
Therapeutic Touch™
(updated
12/14/09 --» What’s
new? )
This page details the evidence
in the literature regarding the effect
of Therapeutic Touch therapy on phantom limb pain. These
cases confirm M.G.’s
report that when a massage therapist passes her hand over M.G.’s
phantom hand during a massage, M.G. feels the “touch”
as tickling and she giggles. In addition, they support the idea that
the
phantom limb in general is objectively real and acts as a
field
extending beyond the physical body, in which physiological sensations
can be
evoked by interaction with another person.
Contents
- Background
- Case
reports
- Discussion
- References
Comments on our work are welcome!
Please feel free to comment on our Discussion Group on the Self-Conscious Mind.
Robert
and Suzanne Mays
What’s
new?
- 12/14/09 - added cases from
Leskowitz, revised description of case from spring 1991
- 11/25/09 - expanded page
- 11/17/09 - started page
Background
Therapeutic
Touch (TT) is a form of energy therapy for balancing the
energy flow in the body through observing and repatterning the
patient’s energy field. Therapeutic touch was developed in
1972 by Dolores Krieger, a nursing professor at New York University.
When administering treatment, TT practitioners hold
their hands an inch or two above the patient’s body without making
physical contact. The practitioner tunes into or “feels” the patient’s
energy field with his/her hands and then manipulates the energy field,
smoothing out the “disordered” field and channeling new energy into the
patient’s body. Therapeutic Touch is thought to affect patients through
the connection of energy fields within and immediately outside the
physical body. The movement of energy stimulates internal physical
mechanisms.
Treatment sessions typically last 5 to 20 minutes, but may
take up to 30 minutes. The treatment protocol consists of a sequence of
five steps (Sayre-Adams, 1993):
- Centering
— to focus attention on the patient and calm the patient’s mind, by
disciplining attention, achieving calm and establishing receptivity
- Assessing
— to evaluate the patient’s energy field for irregularities, through
subtle sensations and intuitive or somatic clues
- Clearing
— to facilitate symmetrical flow of energy through the
patient’s energy field, by sweeping the hands above the patient’s body
downward
- Intervention
or balancing — to assist re-establishing the order in the
system and repatterning the energy field, by smoothing and balancing
over areas where congestion and imbalances persist
- Evaluation/closure
— to verify the effects, through professional, informed and intuitive
judgment, and to conclude the treatment
Phantom limb
pain: A
phantom limb
is the vivid subjective experience that an absent limb (congenitally or
via amputation) is present. Between 90% and 98%
of all amputees
experience a
vivid phantom limb almost immediately after the loss. Within the first few
weeks after amputation, as many as 70% of amputees also experience pain
or discomfort in the phantom, usually intermittently but occasionally
continuously. The pain generally diminishes over time and for some it
disappears, but even after seven years as many as 50% of amputees
continue to experience phantom limb pain (Bloomquist, 2001). Over time
the phantom limb may shorten (“telescope” into the stump),
generally accompanied by a reduction in pain. Phantom pain is more
likely to occur in upper limb amputations, in above the elbow or above
the knee amputations, and with amputations performed on the dominant
arm (Cohen, Christo and Moroz, 2004).
There are several types of phantom pain:
burning, electric current, throbbing, cramping, itching, cutting,
twitching, stabbing, tearing, and crushing.
Preemptive treatment prior
to amputation involves the use of an epidural (spinal) anesthetic
blockade three days before surgery. The results have been positive in
some studies but not others, so the effectiveness of preemptive
analgesia remains controversial.
The
treatment of postoperative phantom
limb pain is difficult and has generally not been successful. Fewer
than 10% of patients with phantom pain receive lasting relief from
prescribed medical treatments. Phantom pain
interventions and treatments include administration of anesthetics,
electric nerve stimulation, administration of anti-depressants and
anti-convulsants, stump revision and physical therapy in preparation
for prosthesis, and psychotherapy (Manchikanti and Singh, 2004).
Neurosurgical techniques such as ablation or transsection of
the
relevant nerves in the stump, spinal cord, thalamus or cortex
generally do not
result in elimination of the phantom limb pain. Such procedures for the
most part have been abandoned (Nikolajsen and Jensen, 2001).
Phantom limb
pain and Therapeutic Touch: There have been at least
a dozen anecdotal reports of the successful
application of Therapeutic Touch in phantom limb pain
treatment. Some of the reports are quite dramatic in the degree and
speed of relief that was achieved. However, Therapeutic Touch is not
100% effective: sometimes nothing happens and sometimes patients need
repeated treatments (Mason, 2002; Leskowitz, 2009). More
research is needed
before
Therapeutic Touch can be recommended as a treatment for phantom limb
pain (Natural Standard, 2008).
Case
reports
A number of cases
have been reported of the use of TT to treat phantom pain in amputees.
The cases have a number of features in common.
- Rupert
Sheldrake (1995, 2002, pp. 152-153) quoted a report from Dr. Barbara
Joyce, head of the graduate nursing program at New Rochelle College,
New York,
about using Therapeutic Touch to reduce pain and discomfort in two
women with leg amputations:
In both
instances patients
reported that Therapeutic Touch used in the field of the missing limb
reduces sensations of itching and pain. Although more clearly with one
patient, but to some degree with the second, I was able
to “feel” the phantom or missing limb and my
estimation of its location in space corresponded with the
patient’s “sensation” of its
location.
- Eric Leskowitz (2000) reported the
case of a 62-year-old man who had undergone a
right-sided below-knee amputation four years earlier and had developed
suddenly recurring sharp, stabbing phantom pain shortly after surgery,
ranging from 8 to 10 out of 10 on a self-reported visual analog scale
(VAS). Various pain medications and therapies were ineffective except
certain antidepressants and combinations of opiate medications. His
pain level was typically 7 or 8
on the VAS and his outside activities were limited to one hour daily.
The patient was given a brief description of Therapeutic
Touch.
He sat on an
examining table with both legs fully extended for the initial
“assessment” phase of the
treatment, which involved manual scanning of the purported energy field
of his phantom limb. Even though his eyes were closed, he was able to
sense the presence of the clinician’s hands in the region of
his phantom limb. When the therapeutic process of distally stroking
the “energy field” was begun, the patient
described a sensation as though his pain were draining down his leg and
out his foot. Within a matter of moments, he was pain free for the
first time since his surgery (0 on the VAS). This period of comfort
lasted several days, until the day before his next scheduled medical
appointment. The night before this appointment, he was
characteristically sleepless, and he felt that this stress caused a
recurrence of his pain. Again, a brief treatment yielded complete pain
relief (0 on the VAS), which again persisted until he next felt
significant life stress several days later. He was then taught a
self-treatment approach in which he could apply the Therapeutic Touch
procedure to his phantom limb and gain similar benefits. At 6-month
follow-up, he reported general absence of pain, which he rated as 0 to
1 on the VAS. He suffered occasional stress-induced pain recurrences
that responded to his self-management process of Therapeutic Touch. He
listened to an audiotape on progressive muscle relaxation and autogenic
training about three times weekly. He was taking no pain medications,
and developed more tolerance of his active lifestyle, which at 6-month
follow-up included daily walks outdoors and daily work at his hobby for
several hours at a time.
- David Maginley (2002) reported the case of an
elderly man who had undergone left leg above the knee amputation and
experienced phantom pain in the absent foot, rated at 8 out of 10.
I explained
the procedure, and he was ‘open to anything that would
work’. Drawing
the curtain, I encouraged the nurse to stay and observe, then centred
and began my assessment. In my hands, I could feel energy flaring from
his the head and stomach which in my mind’s eye seemed to
scream ‘stress!’ His leg was fairly neutral, until I
reached the amputated area. There the energy flared out, with what
seemed like a
static charge down to the missing foot, where it seemed to be
particularly strong. Immediately, I began clearing and grounding.
“Oh,
yes, that’s it,” he said. “I can feel that.
Are you touching me?” I found the
question fascinating, since there was no leg to touch! I could see the
patient quickly relaxing. His body sank into the mattress; his breath
deepened and he gave an audible sigh. He was obviously experiencing
relief from the pain. Grounding the energy field through his missing
foot seemed very effective, the energy moving quickly through left side
of his body and out. Moving my fingers quickly, I pulled the energy out
in strands, making sure to assist the flow as I stayed in touch with
his field and let it lead.
“How’s
the pain now?” I asked. “About 3 out of
10,” he replied. His voice was
soft. I continued to work for more ten minutes, and he fell asleep. The
nurse observing us was thrilled and amazed. “This is a lot
better than narcotics!” she said.
The patient
could not see
what was happening during the treatment as he was lying down, his eyes
were closed, and his head was turned to the right, away from the
left leg. The pain
returned a while later when the patient was awakened suddenly by
another patient’s
behavior but another treatment calmed the patient. After two more
treatments, the phantom pain ceased completely. Maginley reported,
“I could distinctly feel the limb’s energy field, and the
difference in
that energy after clearing and treating the area. The energy in the
phantom foot was particularly pronounced, and this area was confirmed
by the patient during the treatment.”
- Paul Philcox and colleagues (2003) reported a
single blind randomized controlled clinical trial involving 9 clients
assigned randomly to a treatment group receiving TT, a placebo group
receiving mimic TT or a control group receiving no TT. Subjective pain
scores were recorded immediately before treatment, immediately after
treatment and one hour after treatment. The pain scores improved
significantly immediately after treatment in the TT group compared with
the other two groups, and the reduction in pain scores persisted on
hour after treatment in the TT group relative to the other groups but
the difference was not statistically significant. (Our comment: only
the summary of this study is available and the study appears to have
methodological flaws, especially a very small sample size.
Nevertheless,
the observation of a difference using TT is suggestive.)
- Eric Leskowitz (2001) related three cases (see
also Leskowitz, 2008):
Joe was a
35-year-old cargo loader whose leg had been crushed in a work injury,
necessitating an above-knee amputation five years before he presented
to our clinic. His chronic phantom limb pain was only marginally
responsive to a regimen of antidepressants and opiates. He did not
benefit from cognitive-behavioral retraining and was offered a trial of
TT, about which he knew nothing. During the assessment phase, there was
a similar energy presence sensed by the practitioner in the region of
his missing leg that was also felt around the remainder of this intact
body.... At that moment, the patient reported sensing his phantom limb
being touched. As the treatment continued, Joe reported that the pain
sensations seemed to be draining out of the bottom of this phantom
foot. Surprisingly, he asked for the treatment to be stopped before the
pain could be completely alleviated, saying that he feared becoming
pain-free because this would be proof to him that his leg was in fact
missing. In other words, his pain served the psychological function of
defending him against the shock that would come with full acceptance of
his loss....
Ms. B was a 65-year-old widow whose severe diabetic peripheral vascular
disease necessitated a below-the-knee amputation of her right leg....
Within hours of her recovery from surgical anesthesia, she developed
phantom pain of ...two toes.... The pain was not responsive to multiple
medications.... [After psychotherapy her depression lifted] but her
pain persisted. More dramatic results came with the application of
direct energy healing. She, too, was able to feel my hand as it moved
along the phantom limb, and she also felt as though the pain was a
substance that could be guided to drain out of her foot.. The
sensation was so light and gentle that she described it as “blowing in
the wind”... It was also accompanied by a vivid feeling of sky
blue “relaxation” that flowed down her body, seeming to come
from
God before it moved down into her leg. As the phantom pain dissipated,
she became more aware of the pain in her stump, and soon this too left.
After our first energy healing session, she was pain free for the first
time since surgery. However, the physical irritation of being fitted
for a prosthetic leg and the emotional strain of a visit home led to a
relapse of the pain. She then begain to receive daily Therapeutic Touch
sessions from her primary nurse, and learned to observe that her pain
followed a predictable pattern. When she was tired or feeling stressed
(by worrying about the well-being of her agitated and delirious
roommate, for example), her pain recurred shortly after each energy
treatment. If she was well-rested and peaceful, she could be
comfortable all day after treatment. By the time of her discharge, she
had learned to administer Therapeutic Touch to her own leg, and planned
to seek follow up from another physician/healer in her community.
Mr. C. was a 67-year-old man who underwent a right below-the-knee
amputation 17 years before admission to our clinic, because of
peripheral vascular disease. He had suffered alcoholic neuropathy in
both legs prior to surgery, and this neuropathic pain persisted in his
phantom. He responded dramatically to TT treatment, with the pain on
the dorsum of his foot seeming to drain out within 30 secones of the
onset of TT. Unlike the other two cases, neither he nor I sensed the
enrgetic presence of the other's hand or foot during the treatment
session. He slept uninterruptedly that night for the first time in
years. His pain recurred when he returned for follow-up, but he was
able to independently release it when he located a “drainage valve”
near the ball of his phantom foot. Interestingly, this “valve”
corresponded to the origin of the kidney acupuncture meridian, the
so-called “bubbling well” that is a key intake point for life
energy. Mr. C has not required further treatment since his initial
course of 3 TT sessions.
- In another case (personal communication October
17,
2009), an Advanced Practice Nurse worked in spring 1991 with U.S.
servicemen amputees, using Reiki, an energy therapy similar to
Therapeutic Touch. In her first case, a serviceman had lost both legs
in a land mine explosion during the Persian Gulf War, one amputated
above the knee and one below the knee. The patient was experiencing
phantom limb pain and depression. The nurse did “sweeping” movements
over the phantom limbs. The patient at the time had both eyes fully
bandaged due to injuries around the eyes and facial lacerations from
the explosion but could feel and identified correctly where the nurse’s
hands were. The nurse could feel where the phantom limb was and
“smoothed out” the borders and surface of the phantom limb. The patient
felt immediate relief of the pain and his depression lifted. The pain
returned somewhat after one day but after two more therapy sessions,
the patient was pain free and remained so for the more than three
months afterward that the nurse followed his case. The nurse later had
similar results with a number of other amputees at Walter Reed Army
Medical Center.
Discussion
These case reports share a common phenomenology:
- The therapist can feel the phantom limb as
“present” in the expected location, sometimes having a
distinctive “energy”.
- The patient can feel the presence of the
therapist’s
hand in the phantom limb area that the therapist is working in, despite
the fact that the patient cannot see what the therapist is doing (the
eyes are closed, the patient is looking away or the patient’s eyes are
bandaged).
- The patient experiences immediate and dramatic
reduction in the subjective pain.
- Several treatments are required for long-term
pain relief.
- The patient’s pain relief persists but may be
triggered by stress.
The evidence from Therapeutic Touch treatment of phantom limb pain,
while mostly anecdotal, supports the ideas (1) that phantom limbs
are objectively real and act as a field extending
beyond the physical body, and (2) that physiological
sensations can be
evoked in the patient by interaction of the phantom limb with another
person.
References
- Bloomquist, T. (2001). Amputation and phantom
limb pain: A pain-prevention model. AANA Journal, 69(3):211-217.
(Reprint)
- Bowser, M. S. (1991). Giving up the ghost: a
review of phantom limb phenomena. Journal
of Rehabilitation, 57, July, 1991. (Reprint)
- Cohen, S. P., Christo, P. J., and Moroz, L.
(2004). Pain management in trauma patients. American Journal of Physical
Medicine and Rehabilitation, 83(2): 142-161. (Reprint)
- Leskowitz, Eric (2000). Phantom limb pain
treated with Therapeutic Touch: a case report. Archives of Physical Medicine and
Rehabilitation, 81:522-524.
(Reprint)
- Leskowitz, Eric (2001). Phantom limb pain: subtle energy
perspectives. Subtle Energies and Energy Medicine, 8(2):125-152.
- Leskowitz, Eric (2008). Energy-based therapies
for chronic pain. In Joseph F. Audette and Allison Bailey (eds.), Integrative Pain Medicine: The
science and practice of complementary and alternative medicine in pain
management (pp. 225-241). Totowa, NJ: Humana Press. (Preview)
- Leskowitz, Eric (2009). Energy medicine
perspectives on phantom-limb pain. Alternative and Complementary
Therapies, April 2009, 15(2):59-63. (Abstract)
- Maginley, David (2002). Therapeutic Touch and
phantom limb pain. Therapeutic
Touch Network (Ontario) Conference, Toronto, Canada, November, 2002. (Reprint)
- Manchikanti, L., and Singh, V. (2004). Managing
phantom pain. Pain
Physician, 7:365-375. (Reprint)
- Mason, Russ (2002). Alleviating pain with
energy medicine: An interview with Eric Leskowitz, M.D. Alternative and Complementary
Therapies, October 2002, 8(5):278-283. (Reprint)
- Natural Standard (2008). Therapeutic Touch. http://www.naturalstandard.com/
(Reprint)
- Nikolajsen, L., and Jensen, T. S. (2001).
Phantom limb pain. British
Journal of Anaesthesia, 87(1), 107-116. (Reprint)
- Philcox, Paul, Rawlins, Lainie, and Rodgers,
Lynne (2003). Therapeutic Touch for phantom limb pain. Cooperative Connection,
24(3):10-11.
(Summary)
- Sayre-Adams, J. (1993). Therapeutic Touch --
principles and practice. Complementary
Therapies in Medicine, 1(2):96-99. (Reprint)
- Sheldrake, R. (1995, 2002). Seven Experiments that Could
Change the World: A do-it-yourself guide to revolutionary science.
Rochester, VT: Park Street Press.
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