The effectiveness of acupuncture/TENS for phantom limb syndrome. I: A systematic review of controlled clinical trials

Introduction: Phantom limb pain (PLP)/phantom limb sensation (PLS) is common in amputees and difficult to treat but either acupuncture or transcutaneous electrical nerve stimulation (TENS) may provide relief. A systematic review of controlled studies was carried out to explore clinical effectiveness, cost-effectiveness and adverse effects of these treatments on PLP/PLS. Method: Literature searches were carried out using 18 databases (inception February 2013). Reporting quality and risk of bias of controlled studies were assessed by independent reviewers. Results: In two controlled studies, acupuncture significantly improved pain compared with usual care (visual analogue scale 0.17 +/- 0.804 vs. 1.82 +/- 1.919, p<0.05; visual rating scale 1.45 +/- 1.52 vs. 1.81 +/- 2.22, p: not reported); two studies using TENS showed significant improvement in pain compared with sham TENS (pain rating index total F(1.31) = 7.48, p<0.01; pain complain 0/12 vs. 7/12). One study showed better pain relief with TENS stimulation at stumps than stimulation on contralateral side. The reporting quality and methodological quality of controlled studies are critically discussed. Conclusion: There is some evidence for the use of acupuncture and TENS for the treatment of PLP/PLS but insufficient high quality evidence is available. No studies evaluated cost effectiveness or adverse effects. Crown Copyright (C) 2014 Published by Elsevier GmbH. All rights reserved.