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42 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 4 Bodywork Story #2 We had a gentleman come in to our school clinic who had his lower leg amputated. He spoke of phantom limb pain, and the student massaged the missing leg and foot as if it were still there—practicing the techniques she knew in the air of the missing limb. He swore that her massage gave him the most relief. MASSAGE THERAPY FOR AMPUTATION PATIENTS The pain-related complications discussed here fall well within the scope of practice for massage therapists. Indeed, our ability to identify specifi c soft-tissue injuries and address issues of anxiety and depression make massage therapy an excellent choice for many people with amputations. Further, with good guidance from the client, a massage therapist can work directly on the amputated stump to help control edema, deal with neuromas, improve skin health, and loosen local scar tissue. Some specialists specifi cally recommend massage for recent surgeries: "Massage is effective at many levels of pain—tissue level, cognitive level, and nerve level (pain gate). It increases sensory input from the residual limb, and may override the brain's perception of pain. Early massage can help develop tolerance of the residual limb to touch and pressure." 1 Many people, massage therapists and clients alike, marvel at how effective massage therapy can be to help deal with the nerve pain associated with amputation. Working directly on the stump to access irritated nerve endings makes physiological sense, but how is it that clients fi nd relief when a massage therapist literally "goes through the motions" over the missing limb? One explanation may be held in some specialized structures in the brain called mirror neurons. These help us process what we see (and consequently believe) into a perception of sensation. In some protocols, a person with one missing upper or lower limb puts the healthy limb into a specially designed mirror box so it looks as if there is a limb on the other side of the body. When the healthy limb is stimulated in a mirror box, the patient perceives touch to the missing limb. A whole fi eld of mirror therapy has developed to help people with phantom sensation, but also for people with complex regional pain syndrome, longer connected to the source of these sensations in a normal way. Amazingly, neuroplasticity allows us to build new connections in the central nervous system. Sometimes this can happen in very unexpected ways: in one case study, a neurologist was able to map in great detail the sensory stimulus for the missing arm and hand of a patient by tracing a pattern on the patient's face. Her brain had remapped the source of sensation in such a way that touching her face allowed her to "scratch" the itch on her missing limb. TREATMENT OPTIONS FOR AMPUTATION PAIN Pain treatments in conventional medicine typically focus on pharmacologic interventions for these patients. Nonsteroidal anti- infl ammatory drugs can reduce irritation at the nerve endings in the peripheral tissues, while opiates and anti-seizure drugs work on pain transmission and modulation within the central nervous system. All of these drugs carry signifi cant risks of negative side effects, and many doctors and patients are invested in fi nding alternative methods to manage pain in the long term. Follow-up surgeries are sometimes performed to correct neuromas or even to address pain centers within the brain, but these are seldom satisfactory in the long run. This leaves amputation patients with limited options, so many turn to complementary and alternative therapies for relief. We had a gentleman come in to our school clinic who had his lower leg amputated. He spoke of phantom limb pain, and the student massaged the missing leg and foot as if it were still there—practicing the techniques she knew in the air of the missing limb. He swore that her massage gave with neuromas, improve skin health, and loosen local scar tissue. Some specialists specifi cally recommend massage for recent surgeries: "Massage is effective at many levels of pain—tissue level, cognitive level, and nerve level (pain gate). It increases sensory input from the residual limb, and may override the brain's perception of pain. Early massage can help develop tolerance of Many people, massage therapists and clients alike, marvel at how effective massage therapy can be to help deal with the nerve pain associated with amputation. Working directly on the stump to access irritated nerve endings makes physiological sense, but how is it that clients fi nd relief when a massage therapist literally "goes through the motions" over the missing limb? One explanation may be held in some specialized structures in the brain called mirror neurons. These help us We had a gentleman come in to our school clinic who had and the student massaged the missing leg and foot as if it were still there—practicing the techniques she knew in the specialists specifi cally recommend cognitive level, and nerve level (pain gate). It increases sensory input from the residual limb, and may override the brain's perception of pain. Early massage can help develop tolerance of Many people, massage therapists effective massage therapy can be to help deal with the nerve pain associated with amputation. Working directly on the stump to access irritated nerve endings makes physiological sense, but how is it that clients fi nd relief when a massage therapist literally "goes through the One explanation may be held in some specialized structures in the brain called mirror neurons. These help us