by Beth D. Darnall, PhD Expanding global access to phantom pain care
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42 inMotion Volume 20, Issue 6 November/December 2010 Mirror therapy was first described as a receives information that both limbs are phantom leg pain. With minimal instruc- successful treatment for phantom pain intact and functional. It is now widely tion, he purchased a mirror and began by Dr. Vilayanur Ramachandran in the accepted that cortical restructuring occurs doing mirror therapy for 20-25 minutes mid-1990s. Since then, several case reports in the brain when this new information is each day at home. He made sure to have described similar success with the received, and that the restructuring lessens watch the mirror while performing gentle treatment. In 2007, results from a random- or resolves the pain. movements with his intact leg. He simply ized controlled trial of mirror therapy was Historically, mirror therapy is described moved his intact leg any way he wished; published in The New England Journal of as being therapist-guided and it is often he got creative to keep his interest up Medicine. The findings from this study described as involving a specific set of while doing the treatment. He reported showed that mirror therapy was effective exercises that must be followed. However, enjoying the treatment because he found for reducing phantom pain after 4 weeks my research has shown that therapist it relaxing and he started noticing pain of regular practice. Mirror therapy was guidance with mirror therapy is optional, reduction. Within several weeks his also shown to be superior to placebo and and one need not follow a structured set of phantom pain had resolved completely mental visualization comparison groups. exercises to achieve good results. In other and he was able to taper off all of his pain Mirror therapy works by essentially words, mirror therapy is quite simple, medication. “tricking the brain” out of pain. Because and it is something you can do yourself at Based on the success of this case study, pain signals are processed in the brain, home. All you need is a mirror and dedica- we recently conducted a pilot study with we can change the brain “input” and get tion to practice the treatment daily. 40 people with phantom limb pain to different “output” in terms of pain. When I first realized the simplicity of mirror further test the idea that mirror therapy mirror therapy is practiced, the brain therapy after treating a gentleman with can be self-delivered at home. Study
What Is Mirror Therapy?
1. Take a standard mirror (closet-size for leg amputation; shorter for arm amputation). 2. Arm amputation position: sit at a table. Leg amputation position: sit on the floor, sofa or bed. 3. Position the mirror across the midline of the body so the amputation site is hidden behind the mirror. 4. The mirror should reflect the image of the intact arm or leg. Thus, you are able to view your healthy limb and the image of another healthy limb. In this way, the brain encodes the information that no amputation has occurred. 5. Find a way to stabilize the mirror so you are not concerned about balancing the mirror while you perform the treatment. 6. Perform gentle movements while looking in the mirror for 20-25 minutes daily.
Seek Help From a Physical Therapist If: 1. You have trouble staying on track with your daily practice. 2. You are having trouble balancing your mirror or have other trouble getting your mirror set up comfortably. 3. You are depressed; you may benefit from additional personal support. The mirror should be positioned across the midline of the body as shown
Contact the ACA at 888/267-5669 or amputee-coalition.org 43 participants were shown a brief demon- tantly, successful self-treatment may reduce medical resources in many regions of these stration of mirror therapy (either in person suffering and may improve quality of life. countries, self-delivered mirror therapy or via a DVD demonstration) and they While mirror therapy is simple and can may help people with phantom pain from were asked to practice the technique for be done at home, some people may benefit limb loss of all etiologies (causes), includ- 25 minutes daily. Participants self-treated from added structure and guidance (see ing the large percentage of people in these at home with no therapist guidance sidebar, “Seek Help From a Therapist If...”). countries who are survivors of landmines, (however, participants did have the ability Like any behavioral plan, mirror therapy military conflicts or other trauma. I to call me or the study coordinator with only works if it is practiced daily, and questions). Study findings showed that many people may have trouble staying on Related Resources self-delivered mirror therapy is indeed track with a daily practice plan. In these effective for phantom pain. Almost half of cases, seek guidance from a local therapist. Beth Darnall, PhD the participants reported phantom pain (For therapists and individuals unfamiliar “Do It Yourself Mirror Therapy” reduction, with an average pain reduc- with the techniques, please refer to the bethdarnall.com tion of almost 40 percent. Ten participants Resources section of this article for addi- reported phantom pain reduction greater tional information.) Dublin Psychoprosthetics Group than or equal to 40 percent. Two partici- Currently, global outreach efforts are tcd.ie/Psychoprosthetics pants reported 100 percent phantom pain underway to educate physicians and prac- resolution. Like all medical treatments, titioners who treat amputees in developing The End the Pain Project not everyone in the study benefited from countries about mirror therapy and its ease endthepainproject.org mirror therapy, but the study results sug- of use. The End the Pain Project is a non- gest that many patients may effectively profit organization that is providing mirror Vilayanur S. Ramachandran MD, PhD self-deliver mirror therapy at home with a tool kits containing printed instructions for cbc.ucsd.edu/ramabio.html simple mirror. Self-treatment with mirror mirror therapy and nonbreakable mirrors – therapy may reduce pain medication pre- all free of charge to medical organizations Photograph provided by Beth D. Darnall scriptions and medical costs, thus reducing and patients in Vietnam, Cambodia and the cost burden of limb loss. Most impor- Somalia. Due to the limited availability of
44 inMotion Volume 20, Issue 6 November/December 2010