A comparison of the effects of mirror therapy and phantom exercises on phantom limb pain

Bahar Anaforoğlu Külünkoğlu, Fatih Erbahçeci, Afra Alkan, Bahar Anaforoğlu Külünkoğlu, Fatih Erbahçeci, Afra Alkan

Abstract

Background/aim: Although mirror therapy (MT) and phantom exercises (PE) have been shown to reduce pain, the efficacy of these methods in terms of pain, quality of life (QoL), and psychological status (PS) has not been investigated and compared to date. The aim of this study was to determine whether there is any difference between MT and PE in the treatment of phantom limb pain (PLP).

Materials and methods: Forty unilateral transtibial amputees (aged 18–45 years) participated in this study. The subjects were randomly divided into ‘MT group’ and ‘PE group’. QoL was assessed using Short-Form 36 (SF-36), psychological status using the Beck depression inventory (BDI), and pain intensity using a visual analog scale (VAS), before and at the end of the program, and on the 3rd and 6th months thereafter.

Results: All assessments for all parameters improved significantly in both groups (P < 0.05). Comparison of the two groups revealed a significant difference in changes for VAS and BDI in all measurements, and in pre- and posttreatment scores for all SF-36 parameters (except for Role-Emotional) in favor of the MT group (P < 0.05).

Conclusion: While pain intensity decreased and QoL and PS improved in both the MT and PE groups, these improvements were greater in the MT group.

Keywords: Mirror therapy; phantom exercises; phantom limb pain; physiotherapy; rehabilitation.

Conflict of interest statement

CONFLICT OF INTEREST:

none declared

Figures

Figure 1
Figure 1
Mirror therapy (view of the intact limb in the mirror).
Figure 2
Figure 2
Pain intensity during the 28-day treatment period.

References

    1. Ephraim PL Wegener ST MacKenzie EJ Dillingham TR Pezzin LE Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Archives of physical medicine and rehabilitation. 2005;86:1910–1919.
    1. Flor H Phantom-limb pain: characteristics, causes, and treatment. The Lancet Neurology. 2002;1:182–189.
    1. Bosmans JC Suurmeijer TP Hulsink M van der Schans CP Geertzen JH Dijkstra PU Amputation, phantom pain and subjective well-being: a qualitative study. International Journal of Rehabilitation Research. 2007;30:1–8.
    1. MacLachlan M McDonald D Waloch J Mirror treatment of lower limb phantom pain: a case study. Disability and rehabilitation. 2004;26:901–904.
    1. Weinstein SM Phantom limb pain and related disorders. Neurologic clinics. 1998;16:919–935.
    1. Ramachandran VS Hirstein W The perception of phantom limbs. The DO Hebb lecture. Brain. 1998;121:1603–1630.
    1. Nikolajsen L Finnerup NB Kramp S Vimtrup A-S Keller J Jensen TS A randomized study of the effects of gabapentin on postamputation pain. The Journal of the American Society of Anesthesiologists. 2006;105:1008–1015.
    1. Houghton A Nicholls G Houghton A Saadah E McColl L Phantom pain: natural history and association with rehabilitation. Annals of the Royal College of Surgeons of England. 1994;76:22–22.
    1. Jones L Davidson J The long-term outcome of upper limb amputees treated at a rehabilitation centre in Sydney, Australia. 1995;17:437–442.
    1. Pohjolainen T A clinical evaluation of stumps in lower limb amputees. Prosthetics and orthotics international. 1991;15:178–184.
    1. Montoya P Larbig W Grulke N Flor H Taub E Birbaumer N. The relationship of phantom limb pain to other phantom limb phenomena in upper extremity amputees. Pain. 1997;72:87–93.
    1. Wilkins KL McGrath PJ Finley GA Katz J Phantom limb sensations and phantom limb pain in child and adolescent amputees. Pain. 1998;78:7–12.
    1. Kooijman CM Dijkstra PU Geertzen JH Elzinga A van der Schans CP Phantom pain and phantom sensations in upper limb amputees: an epidemiological study. Pain. 2000;87:33–41.
    1. Darnall BD Li H Home-based self-delivered mirror therapy for phantom pain: a pilot study. Journal of rehabilitation medicine. 2012;44:254–260.
    1. Foell J Bekrater-Bodmann R Flor H Cole J Phantom limb pain after lower limb trauma: origins and treatments. The international journal of lower extremity wounds. 2011;10:224–235.
    1. Hanling SR Wallace SC Hollenbeck KJ Belnap BD Tulis MR Preamputation mirror therapy may prevent development of phantom limb pain: a case series. Anesthesia & Analgesia. 2010;110:611–614.
    1. Hsu E Cohen SP Postamputation pain: epidemiology, mechanisms, and treatment. J Pain Res. 2013;6:121.
    1. Chang‐Chien Z Marshall G Huang B Harden M RN Phantom limb pain: a systematic neuroanatomical‐based review of pharmacologic treatment. Pain Medicine. 2014;15:292–305.
    1. Ramachandran VS Rogers-Ramachandran D Synaesthesia in phantom limbs induced with mirrors. Proceedings of the Royal Society of London B: Biological Sciences. 1996;263:377–386.
    1. Weeks SR Anderson-Barnes VC Tsao JW Phantom limb pain: theories and therapies. The neurologist. 2010;16:277–286.
    1. Chan BL Witt R Charrow AP Magee A Howard R Pasquina PF Heilman KM Tsao JW Mirror therapy for phantom limb pain. New England Journal of Medicine. 2007;357:2206–2207.
    1. Mirror therapy in complex regional pain syndrome type 1 of the upper limb in stroke patients. Neurorehabilitation and neural repair. 2009.
    1. Foell J Bekrater‐Bodmann R Diers M Flor H Mirror therapy for phantom limb pain: brain changes and the role of body representation. European journal of pain. 2014;18:729–739.
    1. Ülger Ö Topuz S Bayramlar K Şener G Erbahçeci F Effectiveness of phantom exercises for phantom limb pain: a pilot study. Journal of rehabilitation medicine. 2009;41:582–584.
    1. MacIver K Lloyd D Kelly S Roberts N Nurmikko T Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery. Brain. 2008;131:2181.
    1. Whyte AS Variation in phantom limb pain: results of a diary study. Journal of pain and symptom management. 2001;22:947.
    1. van der Schans CP Geertzen JH Schoppen T Dijkstra PU Phantom pain and health-related quality of life in lower limb amputees. Journal of pain and symptom management. 2002;24:429–436.
    1. Kocyigit H Aydemir O Ölmez N Memis A Reliability and validity of the Turkish version of Short-Form-36 (SF-36) Turkish J Drugs Therap. 1999;12:102–106.
    1. Geisser ME Roth RS Robinson ME Assessing depression among persons with chronic pain using the Center for Epidemiological Studies-Depression Scale and the Beck Depression Inventory: a comparative analysis. The Clinical journal of pain. 1997;13:163–170.
    1. Hisli N Beck Depresyon Envanteri’nin geçerliği üzerine bir çalışma. Psikoloji Dergisi. 1998;6:118–126.
    1. Ramachandran VS Behavioral and magnetoencephalographic correlates of plasticity in the adult human brain. Proceedings of the National Academy of Sciences of the United States of America. 1993;90:10413–10413.
    1. Barbin J Seetha V Casillas JM Paysant J Pérennou D The effects of mirror therapy on pain and motor control of phantom limb in amputees: a systematic review. Annal of Physical and Rehabilitation Medicine. 2016;59:270–275.
    1. Darnall BD Self-delivered home-based mirror therapy for lower limb phantom pain. American journal of physical medicine & rehabilitation/Association of Academic Physiatrists. 2009;88:78–78.
    1. Ramachandran VS Brang D McGeoch PD Size reduction using mirror visual feedback (MVF) reduces phantom pain. Neurocase. 2009;15:357–360.
    1. Moseley GL Graded motor imagery for pathologic pain: a randomized controlled trial. Neurology. 2006;67:2129–2134.
    1. Brodie EE Whyte A Waller B Increased motor control of a phantom leg in humans results from the visual feedback of a virtual leg. Neuroscience letters. 2003;341:167–169.
    1. Brodie EE Whyte A Niven CA Analgesia through the looking‐glass? A randomized controlled trial investigating the effect of viewing a ‘virtual’limb upon phantom limb pain, sensation and movement. European Journal of Pain. 2007;11:428–436.
    1. Brunelli S Morone G Iosa M Ciotti C De Giorgi R Foti C Traballesi M Efficacy of progressive muscle relaxation, mental imagery, and phantom exercise training on phantom limb: a randomized controlled trial. Archives of physical medicine and rehabilitation. 2015;96:181–187.
    1. Sinha R Arokiasamy P Factors affecting quality of life in lower limb amputees. Prosthetics and orthotics international. 2011;35:90–96.
    1. McCartney C Charles D Cooper G Chambers W Smith W Pain and disability following lower limb amputation-a quantitative and qualitative study. Pain Clinic. 1999;11:293–300.
    1. Houston H Dickerson AE Improving functional outcomes for vascular amputees through use of mirror therapy and elimination of the effects of electromagnetic fields. Occupational therapy in health care. 2016;30:1–15.
    1. Asano M Rushton P Miller WC Deathe BA Predictors of quality of life among individuals who have a lower limb amputation. Prosthetics and orthotics international. 2008;32:231–243.

Source: PubMed

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