Abstract
Phantom limb pain (PLP) is prevalent in patients post-amputation and is difficult to treat. We assessed the efficacy of mirror therapy in relieving PLP in unilateral, upper extremity male amputees. Fifteen participants from Walter Reed and Brooke Army Medical Centers were randomly assigned to one of two groups: mirror therapy (n = 9) or control (n = 6, covered mirror or mental visualization therapy). Participants were asked to perform 15 min of their assigned therapy daily for 5 days/week for 4 weeks. The primary outcome was pain as measured using a 100-mm Visual Analog Scale. Subjects in the mirror therapy group had a significant decrease in pain scores, from a mean of 44.1 (SD = 17.0) to 27.5 (SD = 17.2) mm (p = 0.002). In addition, there was a significant decrease in daily time experiencing pain, from a mean of 1,022 (SD = 673) to 448 (SD = 565) minutes (p = 0.003). By contrast, the control group had neither diminished pain (p = 0.65) nor decreased overall time experiencing pain (p = 0.49). A pain decrement response seen by the 10th treatment session was predictive of final efficacy. These results confirm that mirror therapy is an effective therapy for PLP in unilateral, upper extremity male amputees, reducing both severity and duration of daily episodes. NCT0030144 ClinicalTrials.gov.
Highlights
These results confirm that mirror therapy is an effective therapy for phantom limb pain (PLP) in unilateral, upper extremity male amputees, reducing both severity and duration of daily episodes
After amputation of a limb, up to 95% of all patients report painful or non-painful neurologic symptoms, which fall into the category of either residual limb pain (RLP), phantom sensations (PSs), or phantom limb pain (PLP) [1]
Nine amputees were randomly assigned to mirror therapy, while six were randomly assigned to the control group (Figure 1)
Summary
After amputation of a limb, up to 95% of all patients report painful or non-painful neurologic symptoms, which fall into the category of either residual limb pain (RLP), phantom sensations (PSs), or phantom limb pain (PLP) [1]. PSs, or non-painful sensations perceived to be emanating from the phantom limb, typically begin soon after surgery, with one-third of patients reporting. PLP, pain perceived to be emanating from the phantom limb, typically begins within 6 months after amputation and can persist for years, with prevalence rates several years after surgery as high as 85% [4, 5]. Phantom limb pain is extremely difficult to treat as demonstrated by the numerous failed medication trials [6]. While there are many medications used to treat PLP, most have not been tested through rigorous controlled clinical trials, and their efficacies are instead based on positive treatment response for other neuropathic pain conditions [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31]
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