Disease Name Phantom limb pain, also known as phantom limb pain, refers to the patient feels that the severed limb is still there, and pain occurs in the place. The pain occurs at the distal end of the amputated limb, and the pain is of various natures, such as electric shock, cutting, tearing, or burning, etc. The pain is persistent and exacerbated. The pain is persistent and exacerbated by episodes. Various drug treatments are often ineffective. The principle of phantom limb pain, there is no uniform opinion, Western medicine is also a lack of effective treatment. Pathogenesis Chinese medicine has no similar disease name, mostly due to traumatic cuts, phlegm and blood stasis blockage of meridians, long-term heart, liver and cardiac deficiency, brain loss of glory and nourishment, God’s soul disorders, such as dreaming phantom limb pain. The first report of acupuncture treatment of phantom limb pain was published in 1959, for a case of phantom limb pain after amputation. In the 1960s and 1970s, in the course of carrying out research on acupuncture anesthesia and the phenomenon of casket sensation through the meridians, it was found that stimulation of the stump of the affected limb in patients with amputation pain could cause the needle sensation to radiate to the missing part [2]. However, very few articles have been published on the treatment of this condition with acupuncture. Since the 1980s to date, there have been several clinical data, although the accumulation of cases is still small, but basically confirmed that acupuncture has better results. Of course, it is still necessary to seek for more effective acupuncture methods and explore its therapeutic mechanism. According to clinical reports, more than 50% of amputation patients have phantom limb pain after surgery. However, there is no effective means to relieve phantom limb pain. In recent years, basic medical and clinical research has shown that there is a close relationship between phantom limb pain and cortical reorganization, which provides new ideas for clinical relief of phantom limb pain. Amputation and cortical reorganization In the past, it has been believed that the morphology, structure and function of the cerebral cortex of mammals are relatively stable and unchanged after adulthood. However, recent research results have shed new light on this. When the median nerve of adult monkeys was cut off 9 months later, the original sensory area of the cortical somatosensory area (primary somaosensory area SI) changed to feel the incoming signals from the skin adjacent to the cut off innervated cortex, and suggests that the partitioning of the cerebral cortex of the adult monkeys is not absolutely unchanged. In other words, it is likely that the somatic afferent system has a considerable capacity for functional reorganization in adulthood. Another report showed that in a monkey in which the posterior root of the C2 to T4 spinal nerves had been severed for 12 years, the face-hand border in the somatosensory area of the contralateral cortex was shifted by 10-14 cm toward the midline compared with the cortex on the same side of the injury, and that the removal of peripheral sensory afferents may result in a functional reorganization of the cerebral cortex, which was fully confirmed by the animal experiments. This has been well recognized in animal studies. In addition, non-invasive magnetic resonance imaging has revealed the functional reorganization of the cerebral cortex after amputation in humans. Representative areas of the face within the somatosensory region of the contralateral cortex of an adult amputated limb expand and reach toward the midline into representative areas of the amputated hand. Utilizing technology, amputation-like functional reorganization of the cerebral cortex has been successively verified. Thus, amputation of a human limb in adulthood can still lead to a considerable degree of functional reorganization of the cerebral cortex. What is the physiological significance of a functionally reorganized cerebral cortex? In relation to the phantom limb pain that often occurs after amputation, is cortical reorganization related to the development of phantom limb pain? Cortical reorganization and phantom pain Recent studies have shown that cortical reorganization after amputation is likely to be one of the central mechanisms for the development of phantom pain. In patients with phantom pain after amputation, cortical reorganization is evident, whereas in patients without phantom pain after amputation, cortical reorganization is not evident. The degree of functional reorganization of the cerebral cortex was related to the degree of phantom limb pain, while there was no significant relationship with non-painful phantom limb. If brachial plexus anesthesia was applied to patients with phantom limb pain after upper limb amputation, the demarcation line between the functionally reorganized face and hand sensory representative areas (shifted to the midline) appeared to be shifted to the lateral side in the period of pain relief, i.e., there was a tendency to regress to the position before functional reorganization in those patients with significant relief of phantom limb pain after anesthesia. In contrast, those with unrelieved phantom limb pain after anesthesia and those without painful phantom limb sensation had no significant displacement of the demarcation line between the face and hand representative areas before and after anesthesia. This study further suggests that the functional reorganization of the cerebral cortex after amputation may be directly related to the formation of phantom limb pain. Using positron emission tomography (PET), the neural activity induced by painful stimuli in normal subjects appeared in the anterior cingulate cortex, whereas there was no significant change in the cortical activity in the somatosensory representative area. It is suggested that the nociceptive areas in the cerebral cortex of normal adults may be different from those of chronic pain sufferers, including phantom limb pain. Trigger zones of phantom limb pain After amputation, phantom limb sensation may be induced by stimulation of certain areas of the body surface, which are called “trigger zones” (trigger zones). In the case of high amputation of one upper limb with phantom sensation, multiple trigger zones can be found on both sides of the face, neck, upper chest and upper back. If the trigger zones are stimulated with pain, phantom pain can often be induced. The more pronounced the phantom limb pain after amputation, the greater the number of trigger zones that can cause phantom limb pain, and the greater the degree of functional reorganization of the cerebral cortex. In this group of upper limb amputees, no trigger zones were found in the lumbar region, lower abdomen, or both lower limbs. The size of the trigger zone could change over time, but there was always a clear correspondence with the phantom limb. Neural Mechanisms of Phantom Limb Pain The specific processes leading to functional reorganization of the cerebral cortex are multifaceted and may exist at different levels in the peripheral and central nervous systems. In patients with phantom limb pain, there is a reduced degree of cortical functional reorganization after brachial plexus anesthesia, suggesting the importance of peripheral afferent signals in the process of cortical functional reorganization. Functional reorganization also occurs in the somatosensory areas of the cerebral cortex in chronic low back pain. This suggests that peripheral injurious stimulus afferents may be one of the main causes of cortical functional reorganization. The mechanism of phantom limb pain formation at different times after amputation may be different. In the early postoperative period, the afferent and “unmasking” of injurious stimuli from the damaged nerves, and the function of certain normally existing “nerve fiber connections” may be related to the formation of phantom limb pain and the phenomenon of trigger zones in the early period. Thereafter, successive plasticity changes at different levels of the center and continuous injurious stimulation from damaged nerves and from the trigger zone on the surface of the body may further contribute to the functional reorganization process of the cerebral cortex. When the functional reorganization of the cerebral cortex reaches a certain level, prolonged phantom limb pain and the phenomenon of the surface trigger zone may develop. New trends in the clinical care of phantom limb pain In summary, the underlying cause of phantom limb pain after amputation may lie in the altered plasticity of the central nervous system, especially the functional reorganization of cortical somatosensory areas, and peripheral sensory afferents constitute a major factor influencing the functional reorganization of the cortex. These findings are instructive for the clinical care of phantom limb pain. Psychological and clinical manifestations of patients with phantom limb pain In the early period after amputation, patients have difficulty in accepting the fact that they have already existed psychologically, and are unable to get rid of the psychological trauma brought about by the injured limb. Amputation of the limb makes the patient lose the complete self, and is different from normal people. As far as the basic human being is concerned, it can cause inconvenience in life and work, and requires care and concern from time to time, which will bring inconvenience to the people around. In an increasingly competitive society, there is a crisis of losing one’s job, which means that the patient will lose the society on which he or she depends for survival. Physically disabled people are often in the limelight and may be looked at strangely by the world, causing mental stress and pain. This also makes the patient often recall the good old days and the joy brought by the intact limbs, therefore, it is difficult for the patient to change the original thinking and action habits in a short period of time after the amputation. A lower limb amputation patients, after the installation of prosthesis always feel the pain of the residual limb, the reason is that the patient can not accept the fact that the injured limb is still there. Therefore, the psychological barrier and phantom limb pain is closely related. Psychological care Patients often think that the pain cause of phantom limb pain in the residual limb, and look forward to local measures to alleviate, in fact, the root cause is the central nervous system, the residual limb of the local treatment, such as taking analgesics is actually a kind of can not achieve the ultimate effective pain relief effect. To make patients change the understanding of phantom limb pain, first of all to make patients accept the fact of amputation, not only to see the harm and pain caused by the injured limb, but also should realize that amputation can preserve life. From the psychological comfort, life care and help, combined with the patient’s interest, guide their attention, such as sports activities, entertainment and learning to lift the mental pressure, strengthen the limb training is an effective way to shift attention. Through training, patients can change their previous exercise habits, re-adapt to life and work, and move towards society. Experiments have proved that when a certain center is excited, it has an inhibitory effect on other centers (protecting the nociceptive center), so that patients can forget the memory of past pain. Localized Care of the Stump In view of the phenomena that localized injurious afferents to the stump may promote the reorganization of cortical function and the development of phantom limb pain, and that non-injurious stimuli can induce phantom limb pain. We suggest that all types of stimuli to the stump should be minimized. In clinical practice, it is often the case that patients use local strokes and methods such as massage and heat therapy to temporarily relieve the degree of phantom limb pain, which in fact has little effect. In contrast, the data in this review suggest that reducing the afferents of various types of local stimuli to the stump (especially in the early postoperative period) is more conducive to controlling the degree of phantom limb pain. It should also be noted that commonly used analgesics do not reduce the transmission of injurious stimuli from the periphery to the center, and patients should be reminded that reducing local massage is one of the feasible ways to do so, and that this measure is itself an effective way to help distract patients. Issues yet to be explored in practice The phenomenon of trigger zones in the face, neck, upper chest, and residual limbs of patients with phantom limb pain is an issue well worth exploring in depth. Currently, it appears that reducing painful stimuli in the trigger zone is beneficial in reducing phantom limb pain. However, it remains to be investigated whether it is possible to control the degree of phantom pain by administering stimuli of a certain nature to certain trigger zones on the surface of the body to influence the process of cortical functional reorganization after amputation. Most people who have undergone amputation report feeling an illusory limb shortly after the amputation, and a few months later, nearly 30% of amputation patients experience phantom limb pain, and nearly 5% of patients sadly complain that they feel extreme pain in the amputated limb. A small number of patients with phantom limb pain even caused or greatly enhanced such pain when touching other parts of the body or when emotionally disturbed. To date, this phenomenon cannot be explained by current physiologic knowledge, and severing the thalamic tracts of the spinal cord does not permanently eliminate the phantom pain. Treatment Body acupuncture plus head acupuncture (a) Acupuncture points Main points: 2 groups. 1. Fengchi, Fengfu, Si Shencong, Shenting, Neiguan, Shenmen. 2. 1/5 of the upper sensory area (head acupuncture points). Supporting points: lumbar spine, Huanjiao, Chibian, Yanglingquan, Ashigaru, Fenglong, Hangzhong, Taichong. (ii) Treatment: Take one group of main points each time, take the healthy side for the head acupuncture point, take both sides for the double acupuncture points, and the two groups can be used in rotation. In addition to the lumbar spine to take bilateral, ring jump, Chibian to take the affected side, the remaining points are taken on the healthy side. Each time to take 2 ~ 3 points, alternating selection. With a 28-gauge 1.5-inch millimillimeter needle, stabbing to get the qi after the flat tonic and flat diarrhea. Fengfu and Fengchi were not left in needles, and the remaining points were left in needles for 30 minutes. When needling, pay attention to inducing the sensation of needle conduction to the thigh, calf or foot, which often enhances the pain relief effect. Head acupuncture points, into the needle to the required depth, connected to the electroacupuncture instrument, with a continuous wave, the frequency of 200 times / min, the current intensity to the degree of tolerable, energized for 30 to 40 minutes. If the residual end of the affected limb is locally cold, moxa can be used to apply sparrow pecking moxibustion in the place, until the skin is flushed to the degree. The above method once a day, must be continuous treatment for 3 to 4 weeks. (C) the evaluation of the efficacy of the efficacy of the criteria: relief: pain and other symptoms completely disappeared; apparent effect: the degree of pain reduction of more than 50%; effective: the degree of pain reduction of more than 25%; ineffective: the pain and other symptoms of slight or no improvement. This method is mainly used to treat phantom limb pain of the lower extremities, a total of 24 cases, the results: 5 cases of relief, 8 cases of significant effect, 7 cases of effective, ineffective 4 cases, the total effective rate of 83.3%. Body Acupuncture (I) Acupuncture points Main points: 2 groups: 1. Shakuzawa, Neiguan, Shoulder Yu, Quchi, Hegu; 2. Huanjiao, Yanglingquan, Huizhong, Ashisanli, Zhongzhong, Yongquan. Supporting points: also divided into 2 groups: 1. Tianquan, Shaohai, Shenmen, Waiguan, Houxi, Pension; 2. Yinlingquan, Sanyinjiao, Gongsun, Ligou, Chengfu, Kunlun. (ii) Treatment The giant prick method is used, i.e., all the healthy-side points are taken for treatment. Among them: the first group of main points and allied points are used for phantom limb pain in the upper limbs, and the second group is used for phantom limb pain in the lower limbs. The main point is the main point, add the matching points as appropriate, the needle tip is slightly biased downward when needling, and the needle is used to greatly lift the insertion or twisting maneuver after getting gas, so that the needle sensation is dispersed downward through the meridian. Leave the needle for 10 minutes. Once a day, 7 times for a course of treatment, the interval between courses of 3 days. (C) Evaluation of therapeutic effect After observation, this method has a better effect on phantom limb pain, generally a course of treatment can be cured. Auricular acupuncture points (a) Acupuncture points Main points: Shenmen, the corresponding points. Supporting points: subcortical, adrenal gland. Corresponding point location: refers to the lack of limbs in the corresponding part of the auricle to explore the pain-sensitive points. (ii) Treatment Main points are the main points, when the therapeutic effect is not obvious, add or change the use of supporting points, each time to take 1 ~ 2 points. Take the affected side, or take the opposite side or both sides. After the auricle is strictly sterilized, snap-type intradermal needles are inserted with tweezers. When the needle into the patient to feel pain or distension, preferably, into the depth of the needle in order to pierce through the cartilage, not piercing the contralateral side of the skin to the degree, fixed with tape. The patient is instructed to rub the buried needle 2 to 3 times a day for 5 to 10 minutes each time. If the phantom limb pain attack, for any time to press. 3 ~ 5 days to replace 1 time. Note: During the period of burying the needle, the auricle should not be wet or contaminated to prevent infection. Once the buried needle localized redness, swelling and pain phenomenon must immediately ask the doctor to deal with. (C) Evaluation of efficacy of the above method of treatment of a total of 13 cases, phantom limb pain has a good effect on pain relief.