Alternative approaches aid recovery from limb loss

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Losing a limb due to traumatic injury or illness is certainly a life-altering experience. Whether due to a grave illness such as diabetes or cancer, or a serious accident, amputees are often faced with severe pain, emotional and psychological distress and the challenges of learning to regain full function and life skills.

Just ask Bill McFadden of Brampton, Ontario, who is thankful to be alive after a farm accident in late 2003 left him without his right arm. The 27-year-old former carpenter and avid outdoorsman was working on his family’s farm during the holidays when his clothing got caught in a piece of equipment.

The machine “wreaked havoc on me for a couple of minutes,” Bill recalls. He lost his right arm at the scene of the accident and also suffered serious trauma to his left arm, abdomen, legs and jaw.

Bill spent the next two years recovering from his injuries and learning to regain function as a client of Back on Track, the WSIB speciality rehabilitation program at St. John’s Rehab Hospital in north Toronto.

St. John’s Rehab is Ontario’s only hospital dedicated to specialized rehabilitation and named by the province as a benchmark leader in this health-care field.

Bill has benefited greatly from the hospital’s multidisciplinary rehabilitation approach which included physiotherapy, occupational therapy, nursing care, psychosocial and psychological support.

But he still faces an ongoing challenge that is far too familiar to many amputees: severe phantom pain affects him on a regular basis, often for hours at a time. He describes the onset of pain coming so rapidly and severely that he feels as if “someone picked up a hammer and knocked it into my (now missing) right arm.”

Fortunately, Bill was at a unique rehabilitation setting that offers complementary alternative therapy as a key component of pain management. With on-site clinics specializing in chiropody, chiropractic, acupuncture and massage therapy, St. John’s Rehab can seamlessly integrate a variety of techniques that provide optimum care and convenience for patients and community clients.

Bill was referred by his physiotherapist to Zoran Jelicic, a Registered Massage Therapist who offers aquatic massage therapy (AMT) in the hospital’s therapeutic pool.

AMT involves submerging the patient in warm water at about 37C to achieve a neutral temperature inside and outside the body. Floatation devices and the warm water create hydrostatic pressure to counter the effects of gravity.This allows the patient’s tissue and joints to become relaxed and far more receptive to massage in an aquatic environment. The heat, hydrostatic pressure and aquatic environment also affect the nociceptors, or pain receptors, and consequently pain is reduced.

This is particularly effective for phantom pain, which Zoran believes can often be caused by nerve damage and “muscle memory” following traumatic injury.

“Amputees often experience not just the existence of the missing limb, but the feeling that it is stuck in the same position as it was during the accident,” Zoran says. “Aquatic massage allows amputees to relax their muscles, which can simulate a relaxing of the phantom limb and the resulting pain.”

There are psychological and self-relaxation benefits as well. “I often tell clients to concentrate on the relaxed position they experience while in the pool, then visualize warm water or swimming at other times,” Zoran explains.

AMT can often be what Zoran terms a “stepping-stone” therapy, designed for patients who have plateaued in pain management. The goal of AMT in this setting is to help clients progress so they move back to land-based therapies.

Bill has benefited from the only aquatic massage program integrated into a hospital setting in North America. “I don’t like taking pain medicine, so I was willing to try anything,” Bill says. AMT has helped him relax emotionally and physically, and has done wonders for his phantom pain.

Acupuncture is another approach that can benefit people with phantom pain issues. Dr. Adam Chen, Director of the St. John’s Rehab Acupuncture Clinic, explains that different patients respond best to different modalities.

“Western methods such as analgesics, psychotherapy, physiotherapy and occupational therapy help a great deal of patients,” Dr. Chen says. “For other individuals, acupuncture can be a great addition to a full spectrum of care, providing additional health benefits.”

Within only about six acupuncture sessions, Dr. Chen finds that patients can often show a marked response. In some cases, there have been immediate results in reduction of phantom pain, and in higher measured rates of myoelectric activity. Dr. Chen sees this as a new opportunity for research.

Whether it’s a traditional belief that inserting needles into specific points on the body will unblock energy flow, or a modern perspective that acupuncture can interfere with, and reduce pain sensation, more and more individuals are finding pain relief from acupuncture.