A Randomized, Controlled Trial of Mirror Therapy for Upper Extremity Phantom Limb Pain in Male Amputees

Sacha B Finn, Briana N Perry, Jay E Clasing, Lisa S Walters, Sandra L Jarzombek, Sean Curran, Minoo Rouhanian, Mary S Keszler, Lindsay K Hussey-Andersen, Sharon R Weeks, Paul F Pasquina, Jack W Tsao, Sacha B Finn, Briana N Perry, Jay E Clasing, Lisa S Walters, Sandra L Jarzombek, Sean Curran, Minoo Rouhanian, Mary S Keszler, Lindsay K Hussey-Andersen, Sharon R Weeks, Paul F Pasquina, Jack W Tsao

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Registration: NCT0030144 ClinicalTrials.gov.

Trial registration: ClinicalTrials.gov NCT00301444.

Keywords: amputee; mental visualization; mirror therapy; phantom limb pain; upper extremity.

Figures

Figure 1
Figure 1
Patient flow diagram.
Figure 2
Figure 2
Weekly pain scores. Pain scores are reported using the Visual Analog Scale (VAS) measured on a scale of 0–100 mm. Data are presented as mean values.
Figure 3
Figure 3
Pain scores of participants who switched from either covered mirror or mental visualization to mirror therapy. Five participants completed mirror therapy after not responding to treatment in the control group. Their Visual Analog Scale (VAS) pain scores are measured on a scale of 0–100 mm. Patient A reported decreased pain at session 5 but then had return of pain after 2 weeks and switched to minor therapy.

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