The Treatment of Phantom Limb Pain by Scalp Acupuncture By Jason Jishun Hao, DOM, MTCM, MBA; and Linda Lingzhi Hao, DOM, PhD Phantom limb pain, residual limb pain and complex regional pain are common symptoms for patients with limb injuries and amputations. Several studies have shown that approximately 70 percent to 80 percent of patients develop pain within the first few days after amputation. Phantom limb pain is the term for abnormal sensation perceived from a previously amputated limb. Patients may feel a variety of sensations emanating from the absent limb. The limb may feel completely intact despite its absence. The patients often described their pain as burning, squeezing and cramping, or as a prickling, shooting, or stabbing sensation. Residual limb pain is believed to come from injured nerves at the amputation site. Residual limb pain often is associated with phantom limb sensation and pain, and may be related in etiology. Complex regional pain is a "chronic pain syndrome with severe pain, changes in the nails, bones, skin, and an increased sensitivity to touch in the affected limb." Several theories have been proposed regarding the cause of phantom limb pain. An understanding of the mechanisms underlying phantom pain is likely to lead to new and rational types of treatments. Some studies have indicated that phantom pain is thought to originate from the brain. When the area of the brain that controlled the limb before it was amputated no longer has a function, other areas of the brain fill in for it. There is a reorganization of the primary sensory cortex, subcortex and thalamus after amputation. The reorganization of the sensory cortex currently is considered to be responsible for phantom limb pain. Conventional medicine has provided limited help in alleviating these types of pains. Acupuncture, on the other hand, is becoming a more popular method of treatment for acute and chronic pain among nonmedical treatment such as transcutaneous electrical nerve stimulation, vibration therapy, biofeedback, hypnosis massage, physical therapy, and electroconvulsive therapy. Scalp acupuncture has been proven to be the most effective technique for treating central nerve damage, including phantom limb pain, residual limb pain, complex regional limb pain, postconcussion syndrome, posttraumatic stress syndrome, among acupuncture treatments such as body acupuncture, ear acupuncture, and hand acupuncture. Scalp acupuncture is a modern acupuncture technique combining traditional needling method with western medicine knowledge of representative areas of the cerebral cortex. Recent studies have shown that scalp acupuncture could be a very effective form of pain relief for a variety of limb pains. Scalp acupuncture often produces remarkable results with just a few needles. It usually relieves pain immediately, and sometimes only takes several seconds to a minute. The recommended scalp acupuncture areas to be used are sensory area, leg motor and sensory area, tremor area and motor area. The foot motor-sensory areas are known as primary treatment areas to treat limb pain, and bilaterally select the main area to treat all kinds of limb pain. The sensory area is another important treatment area. The upper 1/5 sensory area is unilaterally selected to treat opposing leg and foot pain. The middle 2/5 sensory areas are unilaterally selected to treat opposing arm and hand pain. Tremor areas are classified as secondary areas to treat limb pain, and are bilaterally selected to treat spasm pain on either or both sides. Proper manipulation techniques are crucial for obtaining the desired results. The needles are usually retained for 30 to 45 minutes with stimulation every one to two minutes using a rotational technique every 10 minutes. The patients often are treated two to three times a week, depending upon the degree of pain. Although there certainly are other acupuncture techniques that can be effective, such as ear acupuncture and body acupuncture, scalp acupuncture is a more effective model that brings out quicker, often immediate pain relief. In a recent investigation, scalp acupuncture was applied to treat seven patients with limb pains at Walter Reed Army Medical Center in Washington, D.C., from Feb. 11-12, 2006. After only one treatment for each patient, three of the seven patients instantly felt pain relief and showed significant improvement (43 percent), three patients showed some improvement (43 percent), and only one patient showed no improvement (16 percent), yielding a total effective rate of 86 percent. Chart I: Total effective rate after one treatment of scalp acupuncture Chart II: Effective rate after one treatment of scalp acupuncture Case Study 1: Phantom Pains After both legs were amputated for several months, the patient still felt severe phantom pain. Various types of medication provided little relief. The pain interrupted his sleep and caused loss of emotional control. The patient described severe, painful tingling sensations in both of his feet, with his right foot worse off than the left. As soon as he underwent scalp acupuncture treatment, the patient started to feel heat sensations in both his leg, followed by more tingling and an almost electricity-like sensation in his toes. Five minutes later, his phantom pain had diminished considerably; after 10 minutes, his phantom pains had disappeared completely. The patient was worried that his phantom pains might come back after the needles in his scalp were removed and insisted on sitting in the treatment room for a period after he finished the treatment. He was happy to leave the treatment room without any phantom pain two hours after his first scalp acupuncture treatment. Case Study 2: Residual Limb Pain This patient experienced severe residual limb pain in his right stump right away after his surgery five months ago. He described his chronic pain like the presence of "a wire tight up his leg" with spasms that resulted in an intolerable state. Scalp acupuncture was applied at the foot sensory, motor area and upper 1/5 sensory area. Fifteen minutes after four needles were inserted into his scalp, followed by stimulation of the needles by the doctor, the patient felt a numb and tingling sensation in his leg. After the initial sensation, his tight leg sensation started to loose up. After five more minutes passed, his tight pain leg spasm was almost completely gone. Case Study 3: Complex Regional Pain After being shot twice in each leg during a battle in Iraq, this patient suffered from severe complex regional pain in his right leg. His right leg and foot were so sensitive that even the lightest touch or contact from a thin blanket or sock would induce severe pain the patient could hardly tolerate. The patient lost his ability to stand and walk due to sensitivity on the right foot. As soon as the needles were inserted in his scalp, the patient experienced a "water-bubble-like sensation" moving first from his right hip to his leg, and then to his foot and toes. Five to eight minutes later, his leg and foot pain started to diminish and he was able to make contact with his leg and toes with little discomfort. The patient was so excited to feel the results that he continuingly touched his leg and toes to verify it really was better. He was asked to try to put a sock on his right foot and did so without showing pain or discomfort. The patient then proceeded to take a short nap. The next day, when the doctor returned to the room, the patient was lying on the bed with both socks on. He had very little pain and was much less sensitive to touch. He was able to walk with almost no pain after his scalp was punctured with four needles. Each step he took brought out applause from observers. The other acupuncture techniques for alleviating phantom pain have been proven effective as well. The more commonly practiced techniques are ear acupuncture, body acupuncture and electronic acupuncture. Commonly used ear points are: shenmen, brain, subcortex, sympatric nerve, and corresponding limb points. Commonly used body acupuncture points are LI4, LV3, LV2, P6 H5, SP10, and UB17. The xi-cleft point also is used in existing limbs which have the same meridian names, such as Hand-shaoyang for Foot-shaoyang or left Hand-shaoyang for right Hand-shaoyang. Some researches have found out those certain circumstances, such as emotional stress, anger, fatigue, anxiety, and insomnia, can trigger or enhance the feeling of pain and make them more bothersome. Therefore, the selections of ear and body acupuncture points should be individualized and the treatment setting should be varied among patients according to their symptoms and signs. Electronic acupuncture stimulation of ear points, huantuojiaji extraordinary points, and the sensory cortex of the brain all have very good effects on phantom limb pain, residual limb pain and complex regional pain. Although few scientific investigations have directly assessed the efficacy of acupuncture treatment in limb pain, our treatments show that 86 percent of patients instantly felt effectiveness with only one treatment. Scalp acupuncture treatment for pain relief is accessible, less expensive, safe, and perceived as having fewer side effects. In the future, it would be helpful to conduct controlled studies of effectiveness of such treatment. Scalp acupuncture not only benefits patients with limb pain, but also significantly contributes to our understanding of phantom pain. Furthermore, it may help to discover the mechanisms of phantom limb and residual limb pain and will lead to the discovery of further advancements in pain management. Resources Shunfa J. Scalp Acupuncture and Clinical Cases, Foreign Languages Press, Beijing, China, 1997. McMillian B. Easing the Pain. Published in cooperation with the public Affairs Office, Walter Reed Army Medical Center, Washington D.C., Feb. 17, 2006. Jeffries G E, Phantom Pain Management. March 10, 2006. From www.cripworld.com/amputee/painmanagement.shtml. Yun-Wen Shaw. "Phantom Limb." March 10, 2006. Nikolajsen and Jensen S. Phantom Limb Pain, Retrieved from http://bja.oxfordjournals.org/cgi/content/full/87/1/107. Ramachandran V S and Blakeslee S. Phantoms in the Brain: Probing the Mysteries of the Human Mind. New York, William Morrow, 1998. Medical Encyclopedia, Complex Regional Pain Syndrome, March 18, 2006. Retrieved from www.nlm.nih.gov/medlineplus/ency/article/007184.htm. Dr. Jason Jishun Hao and Dr. Linda Lingzhi Hao received their Masters and PhDs of TCM from Heilongjiang University of Traditional Chinese Medicine in China. They recently were elected president and vice president, respectively, of the International Academy of Scalp Acupuncture. Both have taught classes and workshops on scalp acupuncture since 1982, and currently are practicing in Albuquerque and Santa Fe, New Mexico. They can be contacted via their Web site, www.scalpacumaster.com. Editor's note: If you would like to comment on this article, please contact Acupuncture Today by fax (714-899-4273) or e-mail at . You also are encouraged to discuss this article online at www.AcupunctureToday.com/forums.

Acupuncture Today - September, 2006, Volume 07, Issue 09

Treatment of Multiple Sclerosis by Scalp Acupuncture

By Jason Jishun Hao, DOM, MTCM, MBA and Linda Lingzhi Hao, DOM, PhD

Multiple sclerosis (MS) is a progressive disease of the central nervous system in which communication between the brain and other parts of the body is disrupted. There are multiple scars on the myelin sheaths comprised of a fatty layer surrounding and protecting the neurons of the brain and spinal cord.

Myelin allows for the smooth, high-speed transmission of electrochemical messages between the brain, the spinal cord and the rest of the body. When myelin is destroyed or damaged, the ability of the nerves to conduct electrical impulses to and from the brain is disrupted, which causes the various symptoms of MS. Approximately 300,000 people in the U.S. and 2.5 million people worldwide suffer from MS. It primarily affects adults, with age of onset typically between 20 and 40 years, and is twice as common in women compared to men.
The effects of MS can range from relatively benign in most cases to somewhat disabling. However, the symptoms for some are devastating. Symptoms and signs of MS vary widely depending on the location of the affected myelin sheaths. Common symptoms may include numbness, tingling or weakness in one or more limbs, partial or complete loss of vision, double or blurring of vision, tremor, loss of balance and mobility, unsteady gait, fatigue and dizziness. Some patients also might develop muscle stiffness or spastically, paralysis, slurred speech, dysfunction of urine or bowel, depression and cognitive impairment. MS is unpredictable and varies in severity. In some patients it is a mild illness, but it can lead to permanent disability in others. In the worst cases, patients with MS may be unable to write, speak or walk.MS can occur either in discrete attacks or slowly over time. Although systems functioning may resolve completely between episodes, permanent neurological problems usually persist, especially as the disease progresses. Many risk factors for MS have been identified, but no definitive cause has been found. Currently, MS does not have a cure in terms of conventional treatments. However, a number of therapies can be used to treat the disease symptomatically.

Scalp acupuncture has been proven to have the most success in the treatment of MS and other central nerve damages, as compared to other acupuncture modalities including ear acupuncture, body acupuncture and hand acupuncture. It not only can improve the symptoms, the patient’s quality of life, and slow the progression of physical disability, but also can reduce the number of relapses. Scalp acupuncture, discovered by Dr. Jiao Shunfa in 1971, is a modern acupuncture technique combining traditional needling methods with Western medical knowledge of representative areas of the cerebral cortex, including anatomy, physiology, pathology and neurology.

Scalp acupuncture treatment for MS has had much success in reducing numbness and pain, decreasing spasms, improving weakness and paralysis of limbs and improving balance. Many patients also have reported that their bladder and bowel control, fatigue and overall sense of well-being significantly improved after treatment. Recent studies have shown that scalp acupuncture could be a very effective modality in controlling MS. Scalp acupuncture often produces remarkable results after just a few needles are inserted. It usually relieves symptoms immediately, and sometimes only takes several minutes to achieve remarkable results.

Scalp acupuncture areas may be chosen according to the patient’s particular symptoms. The primary acupuncture areas for patients with motor problems such as paralysis, weakness of limbs or abnormal sensations in limbs, including tingling, numbness or pain, are the motor area and the sensory and foot-motor areas. Those areas should be inserted with needles and stimulated unilaterally or bilaterally, according to the patient’s manifestations. Select the balance area or dizziness area of the scalp, respectively, depending on which symptom the patient manifests. The tremor area of the head should be chosen if patients have limb spasm. Many patients had a very quick positive response in controlling urine and bowel functions when the foot-motor and sensory area is stimulated.

Rotate the needles at least 200 times per minute with the thumb and index finger for one to three minutes. The needles should be twirled as vigorously as the patient can tolerate and repeated every 10 minutes. During the treatment, some patients may have the sensations of some or all of the following: hot, cold, tingling, numbness, heaviness or distending, or the sensation of water or electricity moving along the spine, legs or arms. Those patients with some or all of these sensations usually respond and improve more quickly. However, those who do not have such sensations still could have immediate positive results. Keep the needles inserted for 30 to 45 minutes; the treatment should be administered two to three times per week and a therapeutic course consists of 10 treatments.

There are many different acupuncture techniques to treat MS. Although scalp acupuncture has the fastest track record for improving symptoms, other techniques are also necessary for further improvement. Regular body acupuncture, electric acupuncture and moxibustion, as well as physical therapy and massage, can combine with scalp acupuncture to speed up the time of recovery. Regular acupuncture treatment has been found to have a positive therapeutic effect on the recovery of movements and abnormal sensations of the hands, fingers, feet and toes. Commonly used points are GB-34, LI-3, K-3, ba feng for lower limbs at LI-11, LI-4, SJ-5, and ba xie for upper-limb work. Electrical stimulation is very helpful if the practitioner has difficulty performing the needle rotation more than 200 times per minute. It is suggested that no more than two of the scalp needles be stimulated at any session so the brain does not become too confused to respond. Moxibustion can enhance the therapeutic results of scalp acupuncture, especially for older or weak patients. Recommended points are St-36, Sp-6, CV-4, K-1 and UB-23.

Although there certainly are other acupuncture techniques that can be effective, scalp acupuncture seems to be a more effective model in bringing about quicker and often immediate improvements. In a recent investigation, scalp acupuncture was applied to 16 patients with limb pain at Southwest Rehabilitation Hospital and National Healthcare Center in Albuquerque, N.M. After only one treatment per patient, eight of the 16 patients instantly showed significant improvement (49 percent), six patients showed some improvement (38 percent), and only two patients showed no improvement (13 percent), thus yielding a total effective rate of 87 percent.

Case Study 1: Burning and Stabbing Pain

A 52-year-old female received scalp acupuncture treatment at Southwest Rehabilitation Hospital. After the first symptoms occurred in January 2007, the patient was finally diagnosed with MS in August of that same year. Although various types of medications were provided, she experienced little improvement. The patient described severe burning and stabbing pain throughout her whole body that interrupted her sleep and caused loss of emotional control. She also had occipital headaches and loss of balance that made her unable to walk or turn around. The examination revealed that she could not stand still if her eyes were closed; and she could not turn around, stand on one leg or walk from toe to heel. The movements of touching her nose and touching both index fingers together were only accomplished slowly and with great effort. Her tongue was red and somewhat purple, with a thin white coating. The pulse was wiry and thready.

As soon as she underwent scalp acupuncture treatment, she started to feel the sensations of energy moving down her lower back, followed by heat sensations in her feet. Three minutes later, the burning and stabbing pain diminished considerably. She only felt some of those sensations in her right hip and abdominal area. After 12 minutes had passed, the sensation of burning and stabbing in her entire body had disappeared almost completely, except for some mild sensations in her abdomen. The patient was so excited to feel such dramatic results that she could not wait to test her movements. She was very surprised to find that she had no problem standing with her eyes closed, standing on either leg with the other one raised, walking in a straight line, and turning around without loss of balance. Also, she could now touch her nose and touch her index fingers together like a normal person. By the end of the treatment, her occipital headache had disappeared as well. This patient was happy to tell other MS patients that she felt like a “normal” person (physically and emotionally) after only one scalp acupuncture treatment.

Case Study 2: Paralysis

A 55-year-old female in a wheelchair received scalp acupuncture treatment. After the first symptoms occurred in 1990, the patient finally was diagnosed with MS in 2002. Both of her legs had started to become weak and heavy in the 1990s. Within three years, she was almost paralyzed and finally could not walk at all. The examination revealed she could not stand up straight due to the weakness in her legs, and she was unable to lift her right foot, so she had to drag it behind her while walking. Her tongue was red with a thin white coating; and her pulses were thready and wiry, with weak pulses in the kidney positions.

After four needles were inserted in her scalp, the patient experienced some tingling and electrical sensations in both of her legs. Five minutes later, she felt the urge to move both legs. After exercising her legs by bending and extending them, she was able to stand up straight and walk, free to lift both her feet almost normally. Although it took a lot of effort, she was amazed to be able to walk. At first she needed two people to assist her, then only one person, and finally she was able to walk by herself.

Case Study 3: Dizziness and Vertigo

A 60-year-old female received scalp acupuncture treatment. After the first symptoms occurred at age 20, the patient finally was diagnosed with MS in 1994. Her major symptoms were dizziness and vertigo accompanied by temple headaches that gradually became worse over the next seven years. Sometimes her vertigo was so severe that she felt as if the whole room was spinning violently, which caused her to fall down easily even when she was just standing. Her quality of life was completely diminished, as she had to spend whole days flat on her back with her eyes closed in order to avoid any movement of her head, which aggravated the vertigo. The onset of dizziness and vertigo were exacerbated whenever she changed her position in bed or even moved her head a little bit.

A few years before, the patient had received more than 15 acupuncture treatments from various doctors but experienced little improvement. Upon examination, it was found that her tongue was red with a thick white coating and she had wiry and thready pulses. After two needles were inserted in each temple, the patient reported that she felt some weird sensations in her head that she did not know how to describe. As the doctor stimulated the needles in her head, she was able to explain that it felt like a curtain in front of her eyes had opened. These sensations made her mind clear and her temple headache disappeared. Soon after, her vertigo and dizziness diminished significantly. She moved her head upward, downward, to the left and to the right, testing whether her dizziness and vertigo really were gone. Finally, she announced, “I believe I do not have any dizziness and vertigo anymore. And this was only my first scalp acupuncture treatment!”

Although MS still is an incurable disease of the central nervous system, scalp acupuncture provides an important complementary/alternative treatment approach for improving many MS symptoms and the patient’s quality of life by slowing or reversing the progression of physical disability and reducing the number of relapses. By directly stimulating affected areas of the central nervous system, scalp acupuncture has showed more effective results compared to other acupuncture techniques. Our studies showed that 87 percent of the patients had instant improvements after only one scalp acupuncture treatment. The study also demonstrated that scalp acupuncture treatment for MS is accessible, less expensive, safer, more effective, and caused fewer side effects. Scalp acupuncture not only benefits patients with MS, but also significantly helps us to better understand the mechanisms that cause the condition. It may guide us to the discovery of new effective treatments and hopefully to a cure for this disease in the future.

Resources

1. Wikipedia. Multiple sclerosis. Available at: http://en.wikipedia.org/
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2. Rose JW, Houtchens M, Lynch SG. Multiple sclerosis. Available at: http://library.med.utah.edu/
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3. Sheng A. Acupuncture for multiple sclerosis. Available at: www.americanchronicle.com/articles/25614.
   
4. Hao JJ, Hao LL. The treatment of phantom limb pain by scalp acupuncture. Acupuncture Today, September 2006;6(9).
   
5. Jiao S. Scalp Acupuncture and Clinical Cases. Beijing: Foreign Languages Press, 1997
   
6. AVENOX. Understanding multiple sclerosis and treatment. Available at: www.avonex.com/
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