Tuesday, February 2, 2010
Mirror Therapy performed prior to amputation may prevent Phantom Limb Pain from developing
Phantom limb pains are a common and difficult problem after amputations—even though the injured limb is removed, the pain continues. "The pain pathways in the spinal cord and brain 'remember' the painful injury," says Dr. Shafer. "Because of this memory, the missing arm or leg continues to ache, sometimes severely so, long after the limb itself has been amputated."
Dr. Hanling and colleagues used mirror therapy in an attempt to prevent phantom pain in four soldiers requiring leg amputation because of combat injuries. In each case, amputation was necessary after extensive efforts to save the leg.
Before amputation surgery, the patients performed several sessions of mirror therapy. "In this form of therapy, patients sit with a mirror placed vertically between the legs and arms so that they are reflected in it," Dr. Shafer explains. The reflection in the mirror makes it look like the injured arm or leg is healthy and normal.
"Patients then observe and control their injured arm or leg in the mirror—but they are actually observing and controlling the reflected uninjured arm or leg," says Dr. Shafer. "The brain and spinal cord are visually tricked into believing that all of the arms and legs are intact and without pain."
None of the four soldiers had major problems with phantom pain after amputation. Any episodes of phantom limb pain were brief and mild. Importantly, all patients were able to fully participate in their postoperative physical therapy program.
Mirror therapy appears to re-program the brain's pain circuits into thinking that the painful injury is no longer present, according to Dr. Shafer. "Removing the source of the pain may not let the brain forget this memory, but by controlling, seeing, and reacting to a healthy limb, the brain can be tricked into believing the limb has healed, reducing the risk of phantom limb pain when the injured limb is eventually amputated."
Previous studies have reported the use of mirror therapy in patients with phantom pain that does not respond to other treatments. Although more research is needed, the new results suggest that mirror therapy performed before amputation may prevent disabling phantom limb pain from developing in the first place.
Read the full study in Anesthesia & Analgesia
Subscribe to:
Post Comments (Atom)
Dr. Beth Darnall lent a perspective to Dr. Hanling's findings in O&P BUSINESS NEWS April 1, 2010:
ReplyDeleteThe options for using mirror therapy to treat pain are expanding. In addition to treating amputation-related phantom pain, mirror therapy has been used to successfully treat complex regional pain syndrome, another pain condition that occurs in intact limbs. Moreover, recent research has focused on the use of mirror therapy for post-stroke pain and rehabilitation.
Hanling’s research suggests that the timing of mirror therapy is a critical variable to consider. Not only may phantom pain be prevented for persons with anticipated amputation, but one wonders whether the mirror therapy may also help reorganize brain pathways for the pain conditions that may exist in the limb prior to amputation. This group’s planned functional magnetic resonance imaging studies may speak to this question.
The applications of mirror therapy are expanding and so is our understanding of the simplicity of the treatment itself. Mirror therapy is described in the scientific literature as being therapist-guided and often involves a specific set of mirror exercises. However, my research suggests that home-based, self-delivered mirror treatment is effective for phantom pain. With minimal instruction, patients with phantom pain can treat themselves at home with a mirror purchased from a thrift store. The benefits of home-based self-delivered mirror treatment include low or no cost pain care, reduced medical and physical therapy visits and reduced travel burden. Such benefits are important, particularly for persons in developing countries who have limited access to pain care.
Mirror therapy is proving to be a cost-effective treatment for phantom pain, and early data suggest it may also be helpful for treating other conditions. The simplicity of mirror therapy stands to improve access to pain care for patients around the world.
— Beth Darnall, PhD
Assistant professor
Oregon Health and Science University department of anesthesiology and peri-operative medicine