Pain relief due to TENS and acupuncture in amputees

A. Gneger, T. Eder, K. Reif, M. Morscher, A. Buberl, W. Kickinger, L. Dorfer
Univ. Klinik fur Unfallchirurgie, Wahringergurtel 18-20, Wien, Austria

Purpose Of The Study

Evaluation of the efficacy of amputation pain relief by concomitant TENS and/or acupuncture compared to a standard therapy (NSAID's + morphine derivative drops as rescue, physical and magnetic field therapies). Furthermore if the pain is reduced for a tong term interval (3 and 6 month) induced by these therapies and finally to evaluate if there is a significant reduction of drug consumption.

Methods Used

Inclusion criteria; phantom pain within the last 3 months with a duration of at least 60 min and a min av. VAS-Score of 3. Treatment: 3 weeks with NSAID's (Xefo 8 mg; 2/day); rescue-medication: Nycodol drops. The patients were divided into 4 groups and treated either with drugs alone (G I) or adjuvant with TENS (G II) 3 times a day or body acupuncture (G III) twice a week with ear permanent-needles during the interval or both (G IV). After 7 days, each patient could decide weather to reduce drugs or not. Taken tablets and rescue medication were documented by paramedical personnel. TENS tools: TNS-SM 2 - Schwa-Medico Group with obligate fittings, electrodes placed on the scare ends of the amputated limb, single use acupuncture needles (0.30 x 30 mm) and the ASP ear needles.

Summary Of Results

Till May 31st 1999 we treated 110 patients (45% women, 55 % men, av. age 69.3 and 66.4 y). The left side was affected in 58.8% (64 patients), the right side 41.2% (46 patients). Nearly all of them (94%) were suffering from PAVD and most of them got Type II Diabetes Mellitus (86%), too. Mean VAS Scores: G I = 3.7; G II = 4.2; G III = 3.4; G IV = 4.1; compared to the 3 and 6 months follow up: av. VAS G I = 4.8/5.0; G II = 3.8/3.1; G III = 4.0/2.5; G IV = 3.3/2.8. Meanwhile, 23 patients (20.9%) stopped taking drugs, 6 patients (5.5%) decreased their drug consumption ~50%; 12 patients (10.8%) ~43; 28 patients (25.5%) 25.4% and 41 patients (37.3%) took less than 5% on their own. Among those who reduced drug consumption significantly there were only 9 G I patients (8.2%). 22 patients (20%) stopped the concomitant magnetic field therapy during hospitalisation because of dramatic increase of pain (VAS-Score rose ~3 points or more within one hour after treatment), and nearly all of them (96%) were in GII or GIV.

Conclusions Reached

Subjective pain relief and/or drug reduction and the consequent reduction of undesirable side effects due to complementary pain-therapies as TENS or/and Acupuncture is possible and should be improved "State Of The Art" especially for chronic pain patient and elderly persons. Complementary pain treatment is not a first choice treatment in the acute phase but its importance due to nearly no side effects - especially for long term treatment in elderly patients - should be reconsidered.

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