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Mirror Therapy for Phantom Limb Pain
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See the video and our posters for more detail. Take care with mirror therapy. Remember it is the final part of the entire GMI process and offers potent brain stimulation. You may need to consult a health professional. It is important to be guided by a clinician who understands brain function. For illustrative purposes we have chosen to use a hand as the subject inside the box.
This could also be a foot, leg, shoulder or arm but may require a larger mirror box. Place the other hand in front of the mirror. Leaning forward and comfortably centred, look at the image created in the mirror. If you wriggle the non-painful hand it will feel a little bit odd.
This is just your brain trying to decide what is going on. Presuming there is no jewellery on the affected side, remove any wrist watches and rings from your unaffected side. Herein, we report a case with the successful reduction of phantom limb pain using the mirror therapy when other treatments initially failed to control the pain.
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A year-old male patient received an above-elbow amputation about eight months prior to seeing us for an open fracture on the left radius and ulna due to trauma. He ended up transferring from one department to another department since his condition did not improve at all during treatment due to constant and severe pain after the amputation surgery.
We could not find any specific findings in this medical history.
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He kept complaining about cramping pain on his removed arm and electric-like pain occurring once every few minutes. He also said that he felt the entire shape of his removed arm, and it was medially rotated. Every day, he was prescribed gabapentine 2, mg , oxycodon mg , and amitriptyline 25 mg , with other medications to control the pain. However, the degree of his pain relief was somewhat insignificant and the visual analog scale VAS was out of Other treatment methods, such as stellate ganglion block, thoracic sympathetic ganglion block, brachial plexus block, cervical transforaminal epidural block, and a subcutaneous infusion of ketamine, were also done.
However, they gave the patient only short-term improvement. Lastly, spinal cord stimulation SCS was done for the patient, but the treatment effect was very insignificant. Finally, we performed mirror therapy for the patient. He had to visit the hospital four times a week and went through a minute treatment period. We had the patient feel the movement of his removed arm and hand just like his normal arm and hand moving through a mirror Fig.
After a week passed, the patient said that he could feel his medially rotated arm was back to normal, and his VAS level decreased to 7 out of One month later, he said that the previous cramping pain was almost gone and the phantom hand and arm returned to normal. At that time, his VAS level was 5 out of After, three month from the initial therapy, he is doing a mirror therapy three to four times a week at home.
However, the electric like pain remains and the VAS usually is maintained at 4 out of He is under follow-up at our outpatient department with oxycodon decreased to mg a day. No treatment for phantom limb pain has yet been clearly proven in terms of its effect. Drug therapy includes narcotic drugs, anti-epileptic medications, topical anesthesia, and analgesics.
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An infusion of ketamine, a N-Methyl-D-aspartic acid receptor antagonist, was also introduced for phantom limb pain treatment [ 6 ]. Meanwhile, non-drug therapy includes sympathetic ganglion block, transforaminal epidural block, peripheral nerve block, transcutaneous electrical nerve stimulation TENS , direct cortical or spinal cord stimulation, and mirror therapy, etc.
One of the most effective treatments is mirror therapy. Mirror therapy was unveiled by Ramachandran and Rogers-Ramachandran in Under this therapy, a patient is allowed to feel the imaginary movement of the removed body part behaving as normal body movement through a mirror [ 7 ]. The mirror image of the normal body part helps reorganize and integrate the mismatch between proprioception and visual feedback of the removed body.
Thus, enhancing the treatment effect for phantom limb pain.