Mirror Therapy in Phantom Limb Pain

<br />Through that glass, not so darkly.

Posted Mar 30, 2009

An interesting study was presented a little over a year ago at the national meeting of the American Neurological Association.

The study showed that phantom limb pain was reduced in patients randomized to receive therapy using a mirror to help them visualize moving a normal limb instead of the amputation. But the pain was not reduced in the group where the mirror was covered up, or in another group whose members were asked to imagine moving an amputated foot.

It appears that the visual component of the mirror led to the decrease in phantom limb pain.

Mirror therapy uses a mirror to assist with visual imagery of the amputated limb. It is a method which has been used for the rehabilitation of stroke victims and patients with regional pain syndromes.

In this latest study, performed at Walter Reed Army Hospital, patients with lower limb amputations and significant phantom limb pain were assigned to either mirror treatment, or covered mirror, or mental visualization groups.

The mental visualization group moved the intact foot while visualizing moving the amputated (phantom) foot, accomplishing this by using the mirror to reflect their opposite (intact) foot. This created the illusion of having two completely normal legs.

The covered mirror group also was asked to move their intact foot while visualizing moving the amputated foot, but the mirror, of course, was covered.

The mental visualization group simply closed their eyes and visualized moving the amputated foot.

Patients involved in the study performed their assigned activities 15 minutes each day, 5 days per week. After 4 weeks, it was found that pain was significantly improved in the group using the mirror, with pain levels improving as early as within the first week.

Interestingly, the number and length of the phantom limb pain episodes decreased by 100% in the group using the mirror, decreased by 17% in the covered mirror group, and decreased by 33% in the mental visualization group. But when the patients in the mental visualization and covered mirror groups were switched to the mirror method, these patients also reported significant decreases in pain.

It appears that mirror therapy is a novel and safe therapy for the often perplexing problem of phantom limb pain. The illusion that is created, of a normal limb, appears to be therapeutically successful thanks to the organization and plasticity of the human central nervous system. Researchers are examining the benefit of mirror therapy in complex regional pain syndrome patients. It will be interesting to see those results.

Perhaps the mirror will serve as the glass that is half-filled for those who have suffered horrific injuries.

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