PHANTOM LIMB PAIN:

TREATMENT WITH TECAR® THERAPY AND TENS

D. Orlandini, G. Cavallari,
A.Amoresano

INAIL Prosthetic Centre

Vigorso di Budrio (Bologna), Italy

ABSTRACT
This study was conducted at INAIL Prosthetic Centre in Vigorso di Budrio (Bologna), Italy in order
to test the efficacy of TECAR® therapy in reducing phantom limb pain.
Forty-one patients who had undergone amputation and were suffering from phantom-limb
syndrome were divided into two groups, one treated with TECAR ® therapy and the other with
TENS.
The results showed an immediate and considerable therapeutic action of TECAR® therapy
compared to the administration of TENS.

KEYWORDS

Phantom limb syndrome, analgesia.

It is well known that patients who have undergone an amputation frequently face particular
problems with sensitivity localized in the area of the missing limb, and from this the term
“phantom limb” was coined. Phantom limb is a natural consequence of deafferentation (that is,
when the cerebral and spinal cells lose their afferents) which presents therapeutic problems.
Occasionally, the phantom limb becomes the site of intense pain, and in this case, it becomes a
serious obstacle to completing a rehabilitation program with prosthetics for the amputated limb.

The mechanisms at the basis of the phantom limb and other related phenomena are still only
hypothetical. The experiences associated with phantom limb vary considerably from a precise
replica of the part of the body that was lost to a sensation that is transitory, vague, itchy, or like
pins and needles in parts of the body. On the basis of characteristics that are reported, one can
have sensations that are not always uniform, but varied and/or coexistent, and can also be
described as sensations that are kinaesthetic, exteroceptive, and kinetic.

Any partial sign deserves the phenomenon of telescoping, a phenomenon that refers to the
reduction and disappearance in time of the feeling of non-painful phantom limb; the fingers of the
hand or the toes of the feet gradually come close to the stump until the patient feels attached to it.
If one compares the pain of phantom limb during the attacks, the patient feels the limb gradually
elongating itself again. In the majority of cases the post-amputation pain weakens and then
disappears in the course of two years, while approximately one-third of patients continue to feel
phantom limb pain that is unchanged for many years.

Until now, the treatments proposed for this type of problem (medical therapy, relaxation and
biofeedback techniques, transcutaneous electric stimulation, blocking of sympathetic paravertebral
region, surgical therapy, etc.) have not produced definitive results in the various methods used. At
the INAIL Centre in Vigorso de Budrio, the physical therapies most commonly used were
electric therapy and laser therapy in addition to an occasional massage to peel the scar
tissue at the top of the amputation stub. In the field of electric treatment, the treatment most
commonly used is undoubtedly TENS (Transcutaneous Electrical Nerve Stimulation) for four
fundamental reasons:

• Immediate analgesic effect (Gate Control theory, with action at the spinal cord in Rolando’s
gelatinous substance where there should be a block of pain transmission from the
periphery of the SNC. It is based on a theory of endorphins according to which a weak
nociceptive stimulus, in this case, the electric current used in the treatment, would locally
induce the release of endorphins, resulting in analgesia).
• The absence of observed side effects, above all at the cutaneous level at the top of the
amputation mound.
• The easy handling of the equipment used that allows for home use and/or prolonged
application.
• The acceptable cost of the sessions and of the portable equipment which is accessible for
practically everyone.
•
The electrodes are applied on the “trigger” points (the negative electrode on the more painful
areas and the positive one at a distance of fewer than 3 centimetres away in the target area) and
the intensity of the impulses is regulated on the basis of the sensitivity of the patient (tingling).

A new physical therapy based on energy transfer through electromagnetic waves utilizing
capacitive and resistive contact, TECAR® therapy energy transfer derives its name for its
capacitive and resistive contact, and it attracted our attention after we heard news of its
favourable results obtained in the therapy of pain in sports medicine (CONI-FMSI Institute
for Sports Medicine of Bologna, Italy) and in the treatment of cutaneous scars.

This apparatus, which generates radio waves at low frequency (0.5 MHz), utilizes the principle of
a condenser to alternatively attract and repel electric charge at the internal area of the biological
tissue counterpositioned to the electrode itself.

In this way, thanks to the principles behind its function, energy is recalled from the internal part of
the biostructures, and dehydration and overheating of the tissue are eliminated, and patients with
arthro-prosthetics and osteo-prosthetics can be treated with biological effects (endogenous
microhyperaemia and hyperthermia) at the level of soft tissue or osteoarticular tissue. In
TECAR® therapy, the intensity of the application is correlated to the sensitivity of the patient,
avoiding a sensation of heat in the tissues underlying the electrode. The two types of electrodes
can be used in sequence even within the same session:

Capacitive, insulated electrode: the charges accumulate in proximity to the electrode which must
be continually kept in motion (underlying soft tissue).
Resistive electrode, non-insulated: in this case, the charges accumulate between the electrode
and counterelectrode, localizing themselves in the biological tissues that are more resistive
(tendons, joints, and bone tissue).

The true novelty of this therapy lies in the fact that a magnetic field is not used to create a
generator of secondary current at the internal area of the tissues, but, using the principle of the
condenser, a movement of electric charges is created inside the biological tissue itself
(capacitive current of displacement) enabling the treatment of all layers of the biological tissue
including superficial layers as well as deep layers with selective action on soft tissues as well as
osteoarticular tissue.

The energy transfer, by capacitive and resistive contact in the biological tissues, has various
effects depending on the power that is used:
• Effects at low level (athermic): the use of power at minimal levels results in biostimulation
by increase of endocellular energy transformations (ADP in ATP) with increase in
consumption of oxygen through increase in proliferative processes.
 • Effects at medium level (moderately thermic): in addition to the aforementioned effects,
there is capillary and precapillary microhyperaemia induced by the demand for oxygen by
the tissues in addition to the area controlled by the insulated active electrode.
• Effects at high level (thermic): in the areas treated, in addition to biostimulatory action at
the cellular level, there is also haematic hyperflow, vasodilatation, and increase in
lymphatic drainage.
•
The use of the resistive electrode enables one to obtain the same effects at the level of the
bone tissue with a tridimensional involvement of the treated segment.

MATERIALS AND METHODS

In this study, we treated 40 amputee patients with phantom limb syndrome hospitalized at
the Prosthesis Centre at Vigoroso di Budrio.

The subjects were divided into two groups: the first group of 20 patients ranging in age
from 27 to 84 years (mean 55.35) was treated with TECAR® therapy, and the second group
of 20 patients with ages ranging from 19 to 78 years (mean: 51.05) was treated with TENS.

Each patient was treated from both a clinical and symptomatological standpoint. Upon
admission, a measurement of phantom limb pain was conducted using the Scott-Huskinsson
(VAS) scale with values from 0 to 10 (absent pain, maximum pain); and daily treatment was
planned with TECAR® therapy for a duration of 30 minutes and with a capacitive electrode (15
min.), followed by resistive electrode (15 min.) or with TENS, with sessions occurring at a daily
frequency for 30 minutes.

The applications involved the top of the stump and the sensitive roots along their route to the
spinal cord. At the end of the treatment, an evaluation with VAS scale was re-administered
following a brief individual discussion with the patients, and the results were compared.

RESULTS
As evident from the graphs obtained, though both groups of patients in the majority of cases
achieved notable improvement from the physical therapy that was performed, the group treated
with TECAR® therapy had a modest reduction of subjective pain, with the pain disappearing in
some cases.
YEARS OF AGE AGE DISTRIBUTION OF PATIENTS TREATED WITH TECAR® THERAPY

PATIENTS

AGE OF TENS PATIENTS

YEARS OF AGE

SERIES I
VAS NDEX RESULTS OF PATIENTS TREATED WITH TENS

SERIES I SERIES 2

RESULTS OF TREATMENT WITH TECAR® THERAPY

VAS NDEX

SERIES I SERIES 2
 VAS COMPARISON WITH
TECAR® THERAPY

VAS
VALUE

PATIENTS

Specifically, the group treated with TENS began with a mean VAS of 8.15, and at the end of the
cycle, the mean VAS was 3.305. In comparison, the group treated with TECAR® began with a
mean VAS of 8.365 before the therapy and the final mean VAS was 2.255. Following
discussions carried out with the patients, there emerged other interesting data: if the
graphs are observed carefully, it can be seen that the most evident improvements were
obtained from patients that began with a pain index of 10, or very high number, and we also
noted that while improvements with TECAR® therapy were evident from the first sessions (in some
th th
cases, from the very first session), with TENS, they began from the 5 – 7 session.
We believe that the reason for these differences is tied to various factors: compared to TENS, which acts
exclusively as an electroanalgesic, TECAR® therapy has a more general action on the amputation
stump and after each session, the tissues and scar tissue become more elastic and there is a mild
hyperaemia resulting in improved oxygenation of tissues. It is very important that a close relationship
be developed with the therapist, who dedicates 30 minutes per day to the patient, applying the electrode
on the painful region with a light massage.

CONCLUSIONS

The use of TECAR® therapy ® has shown that in comparison to TENS, TECAR® therapy
has a therapeutic analgesic effect that is more significant and immediate in short term
treatment of phantom limb pain. This is undoubtedly due to the net difference of the
energies used in the treatment of the stumps.

Of course, the case study presented is not very large, but we feel that it is worthwhile to continue
treating patients affected by painful phantom limb syndrome with TECAR® therapy and
eventually vary the protocol used to obtain optimal results by fully utilizing the resources and
potential of the apparatus.

This is also because in training for the use of prosthetics, it is very important to achieve
rapid attenuation of the pain which will allow the patient to feel healthier in general,
enabling the concentration of his energy toward purely rehabilitative aspects related to
prosthetic training.

In regard to evaluation of the stability of the time of the results obtained with the administration of
TECAR® therapy and TENS, a sufficiently reliable follow-up study was not conducted on this first
group of case studies. Therefore, future work will be necessary for an in-depth examination of
this aspect of the problem.

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