Leg Amputation due to Buerger’s Disease: Management with Combined Korean Medicine

In this Case Report, a patient with Buerger’s disease who had a leg amputation below his lower right knee and a vascular bypass of right leg, developed a wound caused by his prosthetic leg and subjective discomfort. The patient received skin flap surgery but the wound did not heal properly. He was admitted to the Korean Medicine Hospital where his wound, right leg coldness, and phantom pain were treated with combined Korean medicine. The patient was hospitalized again where he underwent micro-drilling surgery. The patient was re-admitted to the Korean Medicine Hospital where he received combined Korean medicine treatment (CKMT) and carbon arc light treatment (CALT) for his wound, leg coldness, stiffness, and hypoplasia. The temperature of his right leg increased, the numeric rating scale score for assessing pain fell from 5 to 1.5, and subjective discomfort was reduced (< 20%) suggesting this may be an effective treatment.

Mirror therapy to alleviate Phantom pain

Phantom pain is abnormal commotion of crushing, toes twisting, burning, tingling, cramping and shooting pain that is perceived in a body part that has been amputated or no longer exists. The amount of research in few decades has added enormous knowledge in better understanding of phantom pain. The theories of pain pathways have modified over time from mental theory to peripheral and core neural theories together motor-sensory cortical disassociation and tissue reorganization. In the generation of phantom pain, the role of mirror neurons has recently been steered. To alleviate the phantom pain, pharmacological therapy, physical therapy, TENS therapy, neuromodulation, surgical treatment, bio-integrative behavioural methods and Mirror Therapy has been suggested as treatment modalities. However, there hasn’t been a single treatment option until now. In several randomised controlled trials, mirror therapy is used to manage phantom arm pain and had better outcomes. Multidisciplinary approaches are used in the majority of effective clinical results. In this case report mirror therapy has been used to successfully reduce phantom pain. Keywords: mirror therapy; amputation; mirror neurons; phantom arm pain.

Transcranial Direct Current Stimulation for the Management of Neuropathic Pain: A Narrative Review

BACKGROUND: Neuropathic pain (NP) is common and often resistant to conventional analgesics. Among different types of noninvasive brain stimulation techniques, transcranial direct current stimulation (tDCS) has been widely used to mitigate pain in patients with NP. OBJECTIVE: The aim of this study was to review the effects of tDCS on the management of various types of NP. STUDY DESIGN: Narrative review. METHODS: A PubMed search was conducted for articles published until October 1, 2020, using tDCS to treat NP. The key search phrase, transcranial direct current stimulation and pain, was used to identify potentially relevant articles. The following inclusion criteria were applied for article selection: (1) studies involving patients with NP and (2) studies that used tDCS to treat NP. Review articles were excluded from the analysis. RESULTS: A total of 524 potentially relevant articles were identified. After reading the titles and abstracts and assessing eligibility based on the full-text articles, 34 publications were included in our review. Overall, our results suggest that tDCS induced pain reduction in patients with NP due to stroke or spinal cord injury, multiple sclerosis, or trigeminal neuralgia. There is insufficient evidence to validate the efficacy of tDCS for treating other painful conditions, such as complex regional pain syndrome, phantom pain, or NP of various origins. LIMITATIONS: The review did not include studies indexed in databases other than PubMed. CONCLUSION: The results of the included studies suggest that tDCS may be beneficial in treating patients with NP due to stroke, spinal cord injury, multiple sclerosis, and trigeminal neuralgia. Further studies are recommended to validate the efficacy of tDCS in treating other types of NPs. KEY WORDS: Transcranial direct current stimulation, neuropathic pain, central post-stroke pain, spinal cord injury, multiple sclerosis, complex regional pain syndrome, phantom pain, trigeminal neuralgia

Improvement of Phantom Pain by the Bioresonance Technology

Introduction: Phantom limb pain (PLP) is a sensation caused by missing an organ in the body, which can be due to amputation. The prevalence of PLP due to amputation is about 82% for upper limbs and 54% for lower limbs. Case Presentation: This research describes the case of a 71-year-old female patient who developed PLP after having three middle fingers on her left hand amputated due to dipping in a meat grinder. She underwent bioresonance therapy for PLP treatment for 19 months and achieved positive results. Conclusions: Regarding the role of PLP in the patients undergoing amputation, bioresonance therapy might be beneficial in managing this condition.

Augmented Reality in Physical Therapy: Systematic Review (Preprint)

BACKGROUND Augmented reality is a booming technology. It consists of generating new images from digital information in the real physical environment of a person, simulating an environment where the artificial and the real would be mixed. The use of augmented reality, in physiotherapy, has shown benefits in certain areas of patient health. However, these have not been studied as a whole. OBJECTIVE To determine the use of augmented reality as a complement in physiotherapy. METHODS A systematic review registered in PROSPERO was performed following PRISMA recommendations. The search was conducted from February to April 2020 in the PubMed, PEDro, Web of Science, Scopus, and Cochrane Library scientific databases, using the keywords “augmented reality,” “physiotherapy,” and “physical therapy.” The methodological quality was evaluated using the PEDro scale and the SIGN scale to determine the degree of recommendation. RESULTS Eight articles were included. Fifty percent obtained a high methodological quality and a degree of recommendation of evidence. CONCLUSIONS Augmented reality in combination with conventional therapy has been used for the treatment of balance and fall prevention in geriatrics, lower and upper limb functionality in stroke, and pain in phantom pain syndrome. Further clinical trials are needed using larger sample sizes and with greater homogeneity in terms of the device used and the frequency and intensity of interventions. In general, a promising future is foreseen for augmented reality used as an adjunct in physiotherapy.

Tom Stoppard: European Phantom Pain and the Theatre of Faux Biography

The paper reads Stoppard’s work in the 21st century as further testimony of the gradual politicisation of his work that began in the 1970s under the influence of Czech dissidents, and particularly as a result of his visits to Russia and Prague in 1977. It also provides evidence that Stoppard, since the 1990s, had begun to target emotional responses from his audience to redress the intellectual cool that seems to have shaped his earlier, “absurdist” phase. This turn towards emotionalism, the increasingly elegiac obsession with doubles, unrequited lives, and memory are linked to a set of biographical turning points: the death of his mother and the investigation into his Czech-Jewish family roots, which laid bare the foundations of the Stoppardian art. Examining this kind of “phantom pain” in two of his 21st-century plays, Rock’n’Roll (2006) and Leopoldstadt (2019), the essay argues that Stoppard’s work in the 21st century was increasingly coloured by his biography and Jewishness—bringing to the fore an important engagement with European history that helped Stoppard become aware of some blind spots in his attitudes towards Englishness.

The use of mirror therapy in the treatment of phantom limb pain in amputees

Mirror therapy is a non-invasive and inexpensive therapeutic procedure indicated for the treatment of post-amputation phantom limb pain. This technique has proven its effectiveness and consists of bringing into play brain plasticity in order to reshape the central body architecture after amputation. This is a quantitative and descriptive study, which aims to objectify the use of mirror therapy on phantom pain in amputees, by combining the results in order to evaluate its effects, its application and its limits in the management of post-amputation.