Role of Mirror Therapy for Phantom Limb Pain in Below Knee Amputees

Abstract Objective To describe the development of a virtual reality (VR) treatment for phantom limb pain (PLP) and phantom sensations and provide feasibility data from testing the treatment in a population of veterans. Design & Subjects Fourteen participants completed a baseline visit evaluating their amputation, PLP, and phantom sensations. Subsequently, participants completed a VR treatment modeled after mirror therapy for PLP, navigating in a VR environment with a bicycle pedaler and motion sensor to pair their cadence to a VR avatar. The VR avatar enabled visualization of the participant’s intact phantom limb in motion, a hypothesized mechanism of mirror therapy. Setting Laboratory. Methods Participants completed pre- and post-treatment measures to evaluate changes in PLP, phantom sensations, and rate helpfulness, realism, immersion, adverse experiences, and treatment satisfaction. Results Eight of 14 participants (57.1%) reported PLP pre–VR treatment, and 93% (13/14) reported one or more unpleasant phantom sensations. After treatment, 28.6% (4/14) continued to report PLP symptoms (t[13] = 2.7, P = 0.02, d = 0.53) and 28.6% (4/14) reported phantom sensations (t[13] = 4.4, P = 0.001, d = 1.7). Ratings of helpfulness, realism, immersion, and satisfaction were uniformly high to very high. There were no adverse experiences. Four participants completed multiple VR treatments, showing stable improvements in PLP intensity and phantom sensations and high user ratings. Conclusions This feasibility study of a novel VR intervention for PLP was practical and was associated with significant reductions in PLP intensity and phantom sensations. Our findings support continued research in VR-based treatments in PLP, with a need for direct comparisons between VR and more established PLP treatments.

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Preamputation Mirror Therapy May Prevent Development of Phantom Limb Pain: A Case Series

Anesthesia & Analgesia ◽

10.1213/ane.0b013e3181b845b0 ◽

2010 ◽

Vol 110 (2) ◽

pp. 611-614 ◽

Cited By ~ 20

Author(s):

Steven R. Hanling ◽

Scott C. Wallace ◽

Kerry J. Hollenbeck ◽

Brian D. Belnap ◽

Matthew R. Tulis

Keyword(s):

Case Series ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Mirror Therapy ◽

Limb Pain

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Effectiveness of mirror therapy, motor imagery, and virtual feedback on phantom limb pain following amputation: A systematic review

Prosthetics and Orthotics International ◽

10.1177/0309364617740230 ◽

2017 ◽

Vol 42 (3) ◽

pp. 288-298 ◽

Cited By ~ 22

Author(s):

Laura Herrador Colmenero ◽

Jose Manuel Perez Marmol ◽

Celia Martí-García ◽

María de los Ángeles Querol Zaldivar ◽

Rosa María Tapia Haro ◽

...

Keyword(s):

Systematic Review ◽

Motor Imagery ◽

Visual Feedback ◽

Methodological Quality ◽

Internal Validity ◽

Phantom Limb Pain ◽

Research Quality ◽

Phantom Limb ◽

Mirror Therapy ◽

Limb Pain

Background: Phantom limb pain is reported in 50%–85% of people with amputation. Clinical interventions in treating central pain, such as mirror therapy, motor imagery, or virtual visual feedback, could redound in benefits to amputee patients with phantom limb pain. Objectives: To provide an overview of the effectiveness of different techniques for treating phantom limb pain in amputee patients. Study design: Systematic review. Methods: A computerized literature search up to April 2017 was performed using the following databases: PubMed, Scopus, CINAHL, MEDLINE, ProQuest, PEDro, EBSCOhost, and Cochrane Plus. Methodological quality and internal validity score of each study were assessed using PEDro scale. For data synthesis, qualitative methods from the Cochrane Back Review Group were applied. Results: In all, 12 studies met our inclusion criteria, where 9 were rated as low methodological quality and 3 rated moderate quality. All studies showed a significant reduction in pain, but there was heterogeneity among subjects and methodologies and any high-quality clinical trial (PEDro score ≤8; internal validity score ≤5) was not found. Conclusion: Mirror therapy, motor imaginary, and virtual visual feedback reduce phantom limb pain; however, there is limited scientific evidence supporting their effectiveness. Future studies should include designs with more solid research methods, exploring short- and long-term benefits of these therapies. Clinical relevance This systematic review investigates the effectiveness of mirror therapy, motor imagery, and virtual visual feedback on phantom limb pain, summarizing the currently published trials and evaluating the research quality. Although these interventions have positive benefits in phantom limb pain, there is still a lack of evidence for supporting their effectiveness.

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Effectiveness of Electromyographic Biofeedback, Mirror Therapy, and Tactile Stimulation in Decreasing Chronic Residual Limb Pain and Phantom Limb Pain for a Patient with a Shoulder Disarticulation

JPO Journal of Prosthetics and Orthotics ◽

10.1097/jpo.0000000000000068 ◽

2015 ◽

Vol 27 (3) ◽

pp. 113

Keyword(s):

Tactile Stimulation ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Residual Limb ◽

Mirror Therapy ◽

Limb Pain ◽

Electromyographic Biofeedback ◽

Residual Limb Pain

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Persistent Phantom Limb Pain

Perceptual and Motor Skills ◽

10.2466/pms.1981.53.1.135 ◽

1981 ◽

Vol 53 (1) ◽

pp. 135-138 ◽

Cited By ~ 10

Author(s):

Linda Dawson ◽

Paul Arnold

Keyword(s):

Psychological Factors ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Pain ◽

Personal Problems ◽

Phantom Limbs

The role of psychological factors in 10 patients with painful phantom limbs was investigated by means of a questionnaire and interviews. The hypotheses were that the severity of pain would be positively correlated with their present personal problems and attitudes and with experience of pain in the limb before amputation. The first hypothesis was confirmed but the second was not.

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Psychological Factors Associated with Phantom Limb Pain: A Review of Recent Findings

Pain Research and Management ◽

10.1155/2018/5080123 ◽

2018 ◽

Vol 2018 ◽

pp. 1-12 ◽

Cited By ~ 9

Author(s):

Xaver Fuchs ◽

Herta Flor ◽

Robin Bekrater-Bodmann

Keyword(s):

Chronic Pain ◽

Psychological Factors ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Body Perception ◽

Limb Pain ◽

Psychological Variables ◽

Emotional Factors ◽

Pain Symptoms

Phantom limb pain (PLP) is a common phenomenon occurring after the amputation of a limb and can be accompanied by serious suffering. Psychological factors have been shown to play an important role in other types of chronic pain, where they are pivotal in the acquisition and maintenance of pain symptoms. For PLP, however, the interaction between pain and psychological variables is less well documented. In this review, we summarize research on the role of emotional, motivational, cognitive, and perceptual factors in PLP. The reported findings indicate that emotional factors modulate PLP but might be less important compared to other types of chronic pain. Additional factors such as the amount of disability and adjustment to the amputation appear to also play a role. Bidirectional relationships between stress and PLP have been shown quite consistently, and the potential of stress and tension reduction in PLP treatment could be further exploited. Little is known about the role of cognitive variables such as attention or expectation. Catastrophizing seems to aggravate PLP and could be targeted in treatment. Body perception is altered in PLP and poses a potential target for novel mechanistic treatments. More research on psychological factors and their interactions in PLP is needed.

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