Acupuncture, TENS and Electrostimulation in Phantom Pain: A Bibliography from MEDLINE Abstracts

(Sept 24 1997)
Philip AM Rogers MRCVS,
1 Esker Lawns, Lucan, Dublin, Ireland

PubMed MEDLINE ( was searched on Sept 24 1997 for data on acupuncture and allied methods in the management of phantom pain.

The search profile was ((((ACUP*[All Fields] OR NEEDLING[All Fields]) OR "TRANSCUTANEOUS ELECTRICAL"[All Fields]) OR "NERVE STIMULATION"[All Fields])) AND PHANTOM [All Fields]. The search yielded 38 hits, most of which had abstracts on Medline. The bibliography, sorted by year of publication, follows:
Am J Chin Med 1974 Jul;2(3):247-260. Effect of auriculo-acupuncture on pain. Leung CY, Spoerel WE

Pain 1975 Dec;1(4):357-373. Prolonged relief of pain by brief, intense transcutaneous somatic stimulation. Melzack R. The purpose of this study was to examine the effects of brief, intense transcutaneous electrical stimulations at trigger points or acupuncture points on severe clinical pain. The McGill Pain Questionnaire was used to measure the change in pain quality and intensity produced by stimulation. The data indicate that the procedure provides a powerful method for the control of some forms of severe pathological pain. The average pain decrease during stimulation sessions was 75% for pain due to peripheral nerve injury, 66% for phantom limb pain, 62% for shoulder-arm pain, and 60% for low-back pain. The duration of relief frequently outlasted the period of stimulation by several hours, occasionally for days or weeks. Different patterns of the amount and duration of pain relief were observed. Daily stimulation carried out at home by the patient sometimes provided gradually increasing relief over periods of weeks or months. Control experiments, which included two forms of placebo stimulation, showed that brief, intense electrical stimulation is significantly more effective than placebo contributions. Possible neural mechanisms that underlie these patterns of pain relief by brief, intense stimulation are discussed.

Neurochirurgie 1976 Sep;22(5):517-526. Placement of electrodes in transcutaneous stimulation for chronic pain. [Article in French]. Laitinen L. Forty-six patients with chronic pain were treated with transcutaneous nerve stimulation (TNS). If there were any signs of sensory loss in the pain area, the electrodes were placed on the healthy side of the body. The effect of TNS was assessed quantitatively. After 9 months of repeated TNS, on average, the total pain score had improved by 39%. The subjective intensity of the pain, the frequency of pain and the need for analgesics had diminished by 46-47%. In those conditions in which total improvement was better than the mean (phantom limb pain, 65%; zoster neuralgia, 56%; thalamic pain, 45%), the healthy side of the body had been stimulated. In those in which the painful area had been stimulated (cancer pain, 32%; low back pain, 32%; brachialgia, 15%), the beneficial effect did not reach the mean for the whole series. This suggests that TNS of the healthy side of the body may give better long-term improvement than stimulation of the painful area. A theory of chronic pain and the mechanism of TNS is presented.

Pain 1976 Jun;2(2):149-159. Observations on the analgesic effects of needle puncture (acupuncture). Levine JD, Gormley J, Fields HL. The present study was undertaken in order to investigate the analgesic effect of needle puncture in a small self-selected group of patients with chronic or acute pain, and to examine the factors which determine success or failure of this treatment modality. We have found that in chronic painful conditions, needle puncture may be very effective in producing at least transient analgesia. It also can produce permanent relief of acute (self-limited) pains. Needle puncture was not helpful in the management of pain resulting from nerve damage. High score on psychometric indicators of anxiety and depression is a significant predictor os successful needle puncture analgesia in patients with chronic pain. Comparison of our results to studies of counterirritation indicate that the analgesia produced by needle puncture involves a mechanism similar to that of counterirritation-induced analgesia.

Pol Tyg Lek 1976 Nov 1;31(44):1901-1904   Development of neurosurgical treatment of chronic painful syndromes. [Article in Polish]. Gawlowski J

Vestn Khir 1978 Feb;120(2):135-138. Acupuncture in surgery. [Article in Russian]. Khromov BM

Med Prog Technol 1979 Jun 15;6(3):131-135. Discrimination of phantom hand sensations elicited by afferent electrical nerve stimulation in below-elbow amputees. Anani A, Korner L. The necessity for a sensory feedback system that would enhance patient acceptability of motorized hand prostheses is now generally acknowledged. Afferent electrical stimulation of the nerves in the amputation stump can convey sensory feedback from prostheses with the advantage of eliciting sensations in the phantom image of the lost hand. Experiments with percutaneous nerve stimulation of the amputation stump in below-elbow amputees showed that with stable electrode conditions, amplitude modulated stimulation was better than frequency modulated stimulation in terms of accuracy, delay, and transinformation both with intermittent and uninterrupted stimulation. With unstable electrode conditions, different results were noticed, since amplitude modulated stimulation is very sensitive even to minor changes in electrode position. It is concluded that afferent electrical nerve stimulation with adequate training and stable electrodes had characteristics of accuracy, transinformation and delay which are good enough to make it a suitable method of conveying information in a prosthesis feedback system.

Minerva Med 1979 Dec 15;70(56):3843-3851. Unusual use of reflexotherapeutic technics for control of pain in cases of phantom limb. Spinal and supraspinal theory. [Article in Italian]. Milani L, Roccia L. Treatment of selected cases of amputees suffering from phantom-limbs pains by means of unusual techniques of reflexotherapy is reported. Nose, hand and foot acupuncture and classical auricolotherapy demonstrate in the patients here reported the beneficial effect of these methods. Nosologic, pathologic, clinic results and the anatomo functional mechanisms through which the therapeutic action of reflexoterapy can be explained are discussed. Spinal and trigeminal-reticulo-spinal pathways (central biasing mechanism) are postulated as inhibitory control system for somatic afferences.

Arch Phys Med Rehabil 1981 May;62(5):229-231. Acupuncture in phantom limb pain. Monga TN, Jaksic T. A case of a 36-year-old man, with a history of traumatic amputation below the elbow on the left side, resulting in intractable phantom limb pain, is described. The patient failed to respond to a variety of medications including several analgesics, tranquilizers, and a beta-blocker. Other extended series of conventional treatment modalities, which included stellate ganglion and peripheral nerve blocks and neuromal excision with the anterior transposition of the ulnar nerve, did not relieve the pain. Acupuncture was then attempted with the subjective relief of phantom limb pain and the objective result that the patient could wear a prosthesis.

Middle East J Anaesthesiol 1981 Jun;6(2):69-89. Pain: a review. Afifi AK

Minerva Med 1983 Apr 21;74(17):961-967. Current role of acupuncture in analgesic therapy. [Article in Italian]. Zanini F. After a brief introduction dealing with the great development of acupuncture in management of various painful conditions in the West today, its increased importance, use and role in acute and chronic pain, benign and intractable pain, are discussed. Recent acquisitions about known and yet unknown neurophysiological parameters (evoked cns potentials, endorphines, action of acupuncture in "regulation" of many functions--so called homeostasis--milieu) in connection with good pain relief properties of acupuncture, are referred. The main methods of acupuncture in pain treatment (acupuncture as reflexotherapy--so called electroacupuncture and the very effective auriculotherapy, in comparison with traditional acupuncture as "regulating" method of homeostasis and others minor methods, with our casuistry and positive results in 724 cases of various pain conditions are stressed. Own conclusions about the positive results and the great significance of physician-patient relations in delicate field of pain therapy are referred.

No Shinkei Geka 1983 Dec;11(12):1225-1236. Electrical stimulation for pain relief--spinal cord stimulation. Tanikawa T

Ortop Travmatol Protez 1983 Feb;2:45-48. Acupuncture procedure in the pain syndromes following amputation of the extremities. [Article in Russian]. Pozhidaeva LM, Bogdanov NN, Kachan AT

Postgrad Med J 1984 Dec;60(710):869-875. Painful disorders of peripheral nerves. Parry CB, Withrington RH

Arch Phys Med Rehabil 1985 Jul;66(7):466-467. Phantom limb pain: relief by application of TENS to contralateral extremity. Carabelli RA, Kellerman WC. Three adult patients with below-knee amputation of various etiologies were treated at Norristown's Sacred Heart Hospital and Rehabilitation Center in the fall of 1983. The patients ranged in age from 48 to 64 years and two were men. All three had complaints of phantom limb pain originating from various anatomic sites of the amputated extremity. In all three cases the phantom limb pain was severe and hampered prosthetic training. The patients were treated solely by application of the TENS unit to the contralateral extremity at the sites where the phantom pain originated on the amputated limb. All three patients responded to treatment and were able to continue their prosthetic training. A six-month follow-up showed no pain recurrence of phantom limb pain in all three cases.

Chung Hua Shen Ching Ching Shen Ko Tsa Chih 1985 Dec;18(6):357-360. Phenomenon of the route of sensation propagation and the cerebral cortex. [Article in Chinese]. Xue CC

Ortop Travmatol Protez 1985 Aug;8:38-39. Treatment of phantom pain syndrome by acupuncture-like cutaneous electric stimulation of the contralateral limb. [Article in Russian]. Starobinets MKh, Volkova LD

Chin Med J (Engl) 1986 Mar;99(3):247-252. Acupuncture induced phantom limb and meridian phenomenon in acquired and congenital amputees. A suggestion of the use of acupuncture as a method for investigation of phantom limb. Xue CC

Geriatrics 1987 Dec;42(12):75-77. Chronic pain: use of TENS in the elderly. Thorsteinsson G. Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN. Transcutaneous electrical nerve stimulation (TENS) can be an important adjunct to the management of pain in elderly patients. Chronic neuropathy and postfracture recovery are the leading indications for using the portable stimulative device, although it has also been applied successfully in relieving low-back pain, postherpetic neuralgia, myofascial pain, phantom-limb pain, and advanced, painful malignancies. However, TENS is rarely used alone in pain relief, but instead should be part of a larger management program that may include other modalities.

Neurosurgery 1987 Mar;20(3):496-500. Pain management after lower extremity amputation. Iacono RP, Linford J, Sandyk R. Phantom pain may occur in up to 85% of patients after limb amputation. Although the pathophysiology of postamputation phantom pain is not well understood, it seems to be produced by a complex multifactorial interaction between the peripheral, sympathetic, and central nervous systems. The theoretical aspects of this are reviewed. Management of phantom limb pain may be both medical and surgical. Among the pharmacological agents proved effective against phantom pain are beta-blockers, tricyclic antidepressants, and anticonvulsants. Surgical management includes peripheral nerve stimulation, thermocontrolled coagulation of the spinal cord, spinal cord stimulation, transcutaneous nerve stimulation, and stereotactic deep brain stimulation.

Prosthet Orthot Int 1987 Apr;11(1):17-20. The value of revision surgery after initial amputation of an upper or lower limb. Wood MR, Hunter GA, Millstein SG. The value of revision surgery when carried out more than six weeks after initial amputation of the upper or lower limb was assessed. When performed for stump and/or phantom limb pain alone, only 33/95 (35%) obtained satisfactory results after one revision; 25/95 (26%) of the patients required four or more surgical procedures without relief of pain. However, when carried out for local specific pathology, the results of surgical revision were 100% successful, even if the procedure had to be repeated once in 15% (28/189) of this group of patients. Transcutaneous nerve stimulation appeared to offer no long lasting relief of pain following amputation surgery.

Vestn Khir 1987 Jan;138(1):54-59. Medical rehabilitation of patients after amputation of the leg in sarcoma. [Article in Russian]. Stoliarov VI, Keier AN, Trishkin VA, Shcherbina KK, Ramon F. An analysis of data of 348 patients with malignant tumors of soft tissues has shown that 128 of them had been subjected to the amputation of extremities at different levels. The use of microsurgical techniques favours the improvement of the method of amputation of lower extremities, in particular the transplantation of a calcaneoplantar flap onto the stump end. In order to make the treatment of phantom limb pains more effective acupuncture should be included into the complex of therapeutic measures in addition to traditional methods. Close contacts with prostheses-makers can facilitate earlier prosthesis which can give positive effects on the following rehabilitation of such patients.

J Bone Joint Surg [Br] 1988 Jan;70(1):109-112. Transcutaneous electrical nerve stimulation after major amputation. Finsen V, Persen L, Lovlien M, Veslegaard EK, Simensen M, Gasvann AK, Benum P. Trondheim University Hospital, Department of Orthopaedic Surgery, Norway. We studied the effect of transcutaneous electrical nerve stimulation (TENS) on stump healing and postoperative and late phantom pain after major amputations of the lower limb. A total of 51 patients were randomised to one of three postoperative treatment regimens: sham TENS and chlorpromazine medication, sham TENS only, and active low frequency TENS. There were fewer re-amputations and more rapid stump healing among below-knee amputees who had received active TENS. Sham TENS had a considerable placebo effect on pain. There were, however, no significant differences in the analgesic requirements or reported prevalence of phantom pain between the groups during the first four weeks. The prevalence of phantom pain after active TENS was significantly lower after four months but not after more than one year.

Masui 1988 Feb;37(2):222-225. A case of long-standing phantom limb pain: complete relief of pain. Hirano K, Yamashiro H, Maeda N, Takeuchi T

Acta Anaesthesiol Belg 1989;40(2):121-122. Dorsal column stimulation: its application in pain therapy. Devulder J. Dept. of Anesthesia, Univ. Hospital, Ghent, Belgium. Clinical report about 45 patients treated with dorsal column stimulation.

Acupunct Electrother Res 1989;14(2):121-129. Acupuncture as therapy of traumatic affective disorders and of phantom limb pain syndrome. Freed S. Heart Disease Research Foundation, Brooklyn, New York 11201. Functional isomorphism holds between four essential properties of acupuncture and of meditation, namely, 1) alpha rhythm prominent in electro-encephalograms (EEG); 2) deep general relaxation; 3) high degree of unresponsiveness to ordinarily painful stimuli; 4) participation of virtually the entire body. It is postulated, subject to experimental test, that a "stillness" prevails during acupuncture similar to the quiet of meditation. The quiet of meditation and by postulate, the "stillness" of acupuncture, provide high degree of unresponsiveness to aversive components of conditioned stimuli which had habitually reactivated affective trauma. This marked unresponsiveness accounts for the "stillness" and its EEG alpha rhythm. With its low noise level the "stillness" also provides the cerebral cortex better resolved, more intense signals relative to background and more comprehensive, clear information. The cortex can then call upon newly mobilizable, more precise regulation for removing imbalances throughout the body. The same factors apply to the therapy by acupuncture of phantom limb pain syndrome if the pain impulses from the limb, while attached, is the unconditioned stimulus of a reflex in which impulses from inner organs function as conditioned stimuli. Successful therapy of the syndrome using laser-stimulated acupuncture points is discussed accordingly. Emphasized is the desirability to maximize the "stillness," possibly by monitoring the course of therapy by displayed EEG.

Pain 1989 Mar;36(3):367-377. An association between phantom limb sensations and stump skin conductance during transcutaneous electrical nerve stimulation (TENS) applied to the contralateral leg: a case study. Katz J, France C, Melzack R. Department of Psychology, McGill University, Montreal, Que, Canada. This report describes a placebo-controlled study of transcutaneous electrical nerve stimulation (TENS) applied to the contralateral lower leg and outer ears of an amputee with non-painful phantom sensations. The subject received TENS or placebo stimulation on separate sessions in which baseline periods of no stimulation alternated with periods of TENS (or placebo). Throughout the two sessions, continuous measures of stump skin conductance, surface skin temperature and phantom intensity were obtained. The results showed that TENS applied to the contralateral leg was significantly more effective than a placebo in decreasing the intensity of phantom sensations, whereas stimulation of the outer ears led to a non-significant increase. The pattern of electrodermal activity on the TENS session was consistently linear during baseline periods, indicating a progressive increase in sympathetic sudomotor activity. In contrast, during periods of electrical stimulation the pattern of electrodermal activity was consistently curvilinear indicating an initial decrease followed by an increase in sudomotor responses. Changes in stump skin conductance correlated significantly with changes in phantom sensations both in TENS and placebo sessions suggesting a relationship between sympathetic activity at the stump and paresthesias referred to the phantom. Two hypotheses are presented to account for these findings.

Ortop Travmatol Protez 1990 Apr;4:66-68. Reflexotherapy in orthopedics, traumatology and prosthetics. [Article in Russian]. Kovalenko VV

Can Med Assoc J 1991 Sep 1;145(5):508-509. Chronic pain and the search for alternative treatments. Goldman B

J Neurosurg 1991 Sep;75(3):402-407. Treatment of chronic pain by epidural spinal cord stimulation: a 10-year experience. Kumar K, Nath R, Wyant GM. Division of Neurosurgery, Plains Health Centre, University of Saskatchewan, Regina, Canada. Epidural spinal cord stimulation by means of chronically implanted electrodes was carried out on 121 patients with pain of varied benign organic etiology. In 116 patients, the pain was confined to the back and lower extremities and, of these, 56 exhibited the failed-back syndrome. Most patients were referred by a pain management service because of failure of conventional pain treatment modalities. Electrodes were implanted at varying sites, dictated by the location of pain. A total of 140 epidural implants were used: 76 unipolar, 46 Resume electrodes, 12 bipolar, and six quadripolar. Patients were followed for periods ranging from 6 months to 10 years, with a mean follow-up period of 40 months. Forty-eight patients (40%) were able to control their pain by neurostimulation alone. A further 14 patients (12%), in addition to following a regular stimulation program, needed occasional analgesic supplements to achieve 50% or more relief of the prestimulation pain. Pain secondary to arachnoiditis or perineural fibrosis following multiple intervertebral disc operations, when predominantly confined to one lower extremity, seemed to respond favorably to this treatment. Uniformly good results were also obtained in lower-extremity pain secondary to multiple sclerosis. Pain due to advanced peripheral vascular disease of the lower limbs was well controlled, and amputation below the knee was delayed for up to 2 years in some patients. Pain due to cauda equina injury, paraplegic pain, phantom-limb pain, pure midline back pain without radiculopathy, or pain due to primary bone or joint disease seemed to respond less well. Patients who responded to preliminary transcutaneous electrical nerve stimulation generally did well with electrode implants. Notable complications included wound infection, electrode displacement or fracturing, and fibrosis at the stimulating tip of the electrode. Three patients in this series died due to unrelated causes. Epidural spinal cord stimulation has proven to be an effective and safe means of controlling pain on a long-term basis in selected groups of patients. The mechanism of action of stimulation-produced analgesia remains unclear; further studies to elucidate it might allow spinal cord stimulation to be exploited more effectively in disorders that are currently refractory to this treatment modality.

J Pain Symptom Manage 1991 Feb;6(2):73-83. Auricular transcutaneous electrical nerve stimulation (TENS) reduces phantom limb pain. Katz J, Melzack R. The present paper evaluates the efficacy of low frequency, high intensity auricular transcutaneous electrical nerve stimulation (TENS) for the relief of phantom limb pain. Auricular TENS was compared with a no-stimulation placebo condition using a controlled crossover design in a group of amputees with (1) phantom limb pain (Group PLP), (2) nonpainful phantom limb sensations (Group PLS), and (3) no phantom limb at all (Group No PL). Small, but significant, reductions in the intensity of nonpainful phantom limb sensations were found for Group PLS during the TENS but not the placebo condition. In addition, 10 min after receiving auricular TENS, Group PLP demonstrated a modest, yet statistically significant decrease in pain as measured by the McGill Pain Questionnaire. Ratings of mood, sleepiness, and anxiety remained virtually unchanged across test occasions and sessions, indicating that the decrease in pain was not mediated by emotional factors. Further placebo-controlled trials of auricular TENS in patients with phantom limb pain are recommended in order to evaluate the importance of electrical stimulation parameters such as pulse width and rate, and to establish the duration of pain relief.

Br J Hosp Med 1993 Nov 14;50(10):583-584. Phantom limb pain. Stannard CF. Addenbrooke's Hospital, Cambridge. Phantom limb pain is a common sequel to amputation, whether traumatic or surgical. Provision of a pain-free interval before surgery is likely to reduce the incidence of the condition. The possible mechanisms of pain perception in an absent body part and the reasons for the frequent failure of conventional therapy are discussed here.

Paraplegia 1993 Nov;31(11):722-729. Chronic pain in the spinal cord injured: statistical approach and pharmacological treatment. Fenollosa P, Pallares J, Cervera J, Pelegrin F, Inigo V, Giner M, Forner V. Department of Aneasthesiology, University Hospital, La Fe, Valencia, Spain. We include in this article the results of a postal inquiry into chronic pain in SCI patients in Valencia (Spain), and our experience with their management. A mailed questionnaire including lesion and chronic pain data was sent to all of the 380 SCI patients who live in the region of Valencia. We received 202 answers, with 145 questionnaires being accurately answered and these were analysed for this study. The results show that chronic pain (that is, lasting more than 6 months) is very common (65.5%). The most frequent type was deafferentation pain (phantom pain), described as burning or a painful numbness. Since 1988 we have been treating a sample of 33 patients suffering from resistant pain according to the following therapies: 1 amitriptyline + clonazepam+NSAID (nonsteroidal antiinflammatory drugs); 2 amitriptyline + clonazepam + 5-OH-tryptophane + TENS (transcutaneous electrical nerve stimulation); 3 amitriptyline + clonazepam + SCS (spinal cord stimulation); 4 morphine, by continuous intrathecal infusion. After almost 4 years using these therapies we can affirm that the results regarding analgesia reached 80% in all cases, and that morphine used by intrathecal route is very safe and useful in selected patients.

Reg Anesth 1993 Mar;18(2):121-127. Phantom limb pain. Wesolowski JA, Lema MJ. Department of Anesthesiology and Critical Care Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263-0001.

Stereotact Funct Neurosurg 1994;62(1-4):273-278. Italian multicentric study on pain treatment with epidural spinal cord stimulation. Broggi G, Servello D, Dones I, Carbone G. Istituto Nazionale Neurologico C. Besta, Milano, Italia. A multicentric study on the treatment of nonmalignant chronic pain with epidural spinal cord stimulation (SCS) has been carried out in 32 Italian centers devoted to pain therapy. Neurosurgical and anesthesiology units participated in this retrospective study. 410 of the eligible patients were enrolled in the protocol: 48% were male, 52% female. All patients underwent a screening test period (average 21 days) and 74% underwent the definitive implant. The diagnosis was failed back surgery syndrome in 45%, reflex sympathetic dystrophy in 15%, phantom limb pain in 14%, postherpetic neuralgia in 8%, peripheral nerve injury in 5%, others 13%. 84% received noninvasive unsuccessful treatment (10 tensor acupuncture). All had previous pharmacological therapy which was not always discontinued when SCS took place. Pain assessment had been done with the visual analog scale and verbal scale both subjectively and by the physician and nurses. Neuropsychological profile with minimal mental test or MMPI was obtained in 68% of the patients. These results were favorable (i.e. excellent or good; more than 50% reduction of pain) in 87% of the patients at the 3-month follow-up, 75% at the 6-month follow-up, 69% at the 1-year follow-up, and 58% at the 2-year follow-up. Complication rate was: dislocation of the electrocatheter 4%, technical problems 3%, infections of the system 2%. The results will be discussed in correlation with the different etiologies of the nonmalignant chronic pain syndrome.

Anesteziol Reanimatol 1995 Mar;2:97-102. Evaluation of the effectiveness of transcutaneous electroneuroanalgesia in phantom pain syndrome. [Article in Russian]. Gnezdilov AV, Syrovegin AV, Plaksin SE, Ovechkin AM, Ivanov AM, Sul'timov SA. Transcutaneous electroneurostimulation carried out in 24 patients with phantom pain syndrome completely relieved pain in only 25% of patients. A possible cause of poor efficacy of this method is depletion of the endorphin antinociceptive mechanisms. EEG findings indicated a possibility of objectively controlling the course of analgesia. Specific EEG signs of phantom pain syndrome were distinguished: polymorphism of EEG fluctuations, high-frequency rapid or slow electrical activity of the brain, and paroxysmal activity. Normalization of EEG, i.e. appearance of manifest alpha-rhythm, reduction of the intensities of slow-wave and rapid activities with the relevant spectral changes, are signs of a positive effect of the analgesic method used, as exemplified by transcutaneous electroneurostimulation.

Med Biol Eng Comput 1995 May;33(3 Spec No):403-408. Three-dimensional current density distribution under surface stimulation electrodes. Sagi-Dolev AM, Prutchi D, Nathan RH. Biomedical Engineering Program, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Overflow to non-target tissue during FNS can be reduced by controlling current density distribution under surface stimulating electrodes. A method is introduced for the acquisition of 3-D current density distributions under complex surface stimulating FNS electrode geometries. The method makes use of a phantom model in which a conventional homogeneous model has been improved by adding a layer to simulate skin impedance properties, based on specific FNS parameters. Signal acquisition and processing circuits have been developed to simulate the process by which excitable tissue responds to external stimulation. In addition, a data analysis method has been introduced to allow for the characterisation of stimulation current intensity, electrode geometry and pulse waveform required to achieve target muscle activation, with minimal overflow and to avoid pain or burning. Measurements of integrated differential voltage corresponding to current density distribution acquired under electrodes of various geometries are presented in terms of 3-D attenuation coefficient maps as examples of the applicability of the method.

Br J Anaesth 1997 Jun;78(6):652-659. Phantom pain and sensation among British veteran amputees. Wartan SW, Hamann W, Wedley JR, McColl I. (UMDS-Anaesthetics), Guy's Hospital, London. Using a mail-delivered questionnaire, we surveyed 590 veteran amputees concerning phantom pain, phantom sensation and stump pain. They were selected randomly from a population of 2974 veterans with long-standing limb amputation(s) using a computer random number generator. Eighty-nine percent responded and of these, 55% reported phantom limb pain and 56% stump pain. There was a strong correlation between phantom pain and phantom sensation. The intensity of phantom sensation was a significant predictor for the time course of phantom pain. In only 3% of phantom limb pain sufferers did the condition become worse. One hundred and forty-nine amputees reporting phantom pain discussed their pain with their family doctors; 49 were told that there was no treatment available. Transcutaneous electric nerve stimulation, analgesics and non-steroidal anti-inflammatory drugs were satisfactory methods for controlling phantom limb pain.