A Clinical Trial of Mirror Treatment for Phantom Pain

A Randomized Controlled Clinical Trial of Mirror Treatment in the Management of Phantom and Residual Limb Pain in Patients With Trans-tibial Land Mine Amputations in Cambodia

A randomized controlled clinical to examine the effect of mirror therapy on phantom pain and residual limb pain in patients with traumatic transtibial amputations in Cambodia. The study will be conducted with a semi-crossover design using self-rated pain and function as the main result variables.

Study Overview

• Status: Completed
• Conditions: Complex Regional Pain Syndromes; Phantom Limb Pain
• Intervention / Treatment: Other: Tactile treatment; Other: Mirror treatment

Detailed Description

The study will be conducted in two phases: Firstly, the effects of mirror treatment (M) versus tactile treatment (T) will be compared in an open, randomized, semi-cross-over case-control design study. The second phase includes the responders from the initial treatment (M or T), the duration of the initial treatment effect will be observed, and the effect of a second round of similar treatment will be registered.

Phase one: The study patients will be randomized for M or T treatment. The main outcome variables will be gathered before the initial randomization and after an initial treatment period of three weeks. Non-responders (NR) will be allocated for an immediate second three-weeks treatment period of combined treatment (M+T); the responders (R) of the M, T and M+T enter the second phase of the study. The M+T non-responders discontinue the study.

Phase two: The responders will be observed for a period of maximum three months. When symptoms of phantom limb pain and/or CRPS resume, the patients will undergo a second treatment period with the same treatment as during phase one. The duration of the second treatment period will be maximum three weeks, but each patient may decide to interrupt the treatment at an earlier stage if he finds the effect satisfactory. The main outcome indicators will be gathered at the start and the end of the second treatment period.

The study closes at the end of the second treatment period. For both study phases the treatment effects will be compared between the strata and also inside each stratum, using each patient as his own control.

• Study Type: Interventional
• Enrollment (Actual): 45
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Cambodia
  • Battambang, Cambodia, 5004
    • Trauma Care Foundation Cambodia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 3 days and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Present age >16 years.
• Unilateral trans-tibial land mine amputation more than 12 months before entering the study.
• Suffering from phantom limb pain and/or CRPS-2.

Exclusion Criteria:

• Amputation stump anomalies that require surgical reconstructions such as chronic infections, neuroma or major soft tissue deformities.
• Chronic alcoholism or drug abuse.
• Loss or deformities of limbs other than the actual amputation.
• Mental and/or cognitive disorders making self-reporting unreliable.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mirror treatment; Five minutes treatment period twice a day for three weeks	Other: Tactile treatment; In Tactile Treatment five different sensory stimuli is applied repeatedly to the skin of the affected part of the limb, in the actual case to the amputated limb from ten cm above the knee joint and distally to include the entire amputation stump: gentle touch with a feather, a brush, a piece of paper, a stone and a wooden stick. The stimuli are applied two times daily for five 5 minutes each time, one minute per material.
Active Comparator: Tactile treatment; Tactile massage twice a day for three weeks	Other: Mirror treatment; The mirror treatment: The patient sits on a chair, both knees in 90 degrees flexion, both lower limbs undressed, and places a mirror of 100 cm x 25 cm along the trans-tibial amputation stump so that the uninjured limb is reflected in the mirror while the amputation stump can not be seen by the patient. The patient then performs slow repeated movements of the foot from neutral position into maximum flexion while closely observing the reflected image of the uninjured limb - the illusion of a limb regained - in the mirror. The procedure goes on uninterrupted for five minutes in the morning and in the evening in the home of the study patient.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Phantom limb pain	Assessed by self-rating by each study patient	Change after three months as compared to preintervention level

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Physical function	Assessed by questionnaire	Change after three months as compared to preintervention level

Collaborators and Investigators

• Sponsor: Trauma Care Foundation, Norway
• Collaborators: University Hospital of North Norway; NCHADS - Ministry of Health of Cambodia
• Investigators: Study Director: Snorre Sollied, MD, PhD, Department of Intensive Care, University Hospital North Norway

Study record dates

Study Major Dates

• Study Start: March 1, 2016
• Primary Completion (Actual): March 1, 2017
• Study Completion (Actual): July 15, 2017

Study Registration Dates

• First Submitted: January 3, 2016
• First Submitted That Met QC Criteria: September 21, 2016
• First Posted (Estimate): September 23, 2016

Study Record Updates

• Last Update Posted (Actual): October 18, 2017
• Last Update Submitted That Met QC Criteria: October 17, 2017
• Last Verified: October 1, 2017

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Postoperative Complications; Pain; Neurologic Manifestations; Neurobehavioral Manifestations; Neuromuscular Diseases; Peripheral Nervous System Diseases; Autonomic Nervous System Diseases; Perceptual Disorders; Pain, Postoperative; Complex Regional Pain Syndromes; Reflex Sympathetic Dystrophy; Phantom Limb
• Other Study ID Numbers: 975 905 055