Mirror Therapy: Seeking Relief Through the Looking Glass

6/52 "phantom limbs"

6/52 “phantom limbs” (Photo credit: porschelinn)

Phantom limb pain (PLP) and phantom limb sensation (PLS) have long intrigued physicians and clinical psychologists.  PLP is commonly seen in people who have lost a limb due to disease or trauma. Although it no longer exists, the phantom limb becomes the location of severe pain, characterized as cramping, shooting, squeezing, stabbing, throbbing or burning. In addition, phantom limbs are often perceived as paralyzed in an unnatural position or shape. Following amputation, virtually all patients experience PLS, painful or not. Essentially, the brain remembers the missing part of the limb and is still reporting its feelings. A person with PLS may feel numbness, tingling, heaviness, temperature change, pressure, constriction, reduced or changing limb length and a sense of voluntary movement in the phantom limb.

V.S. Ramachandran, MD, is the developer of the mirror box treatment for PLP. The theory proposes that when a patient gets visual feedback (i.e., using a mirror) that the phantom limb is obeying the brain’s command, the learned paralysis or pain is sometimes “unlearned.”  His original mirror box treatment evolved into the use of a single mirror.

To explore the phantom limb phenomena, Ramachandran conducted a study of 10 arm amputees using the mirror box to generate an illusion of a missing limb. Patients were instructed to place their amputated limb behind the mirror and to place their surviving limb in front of the mirror while freely moving the intact arm and hand. When the patients looked into the mirror they saw the illusion (image) of their missing limb as being intact and moving freely. Six participants experienced phantom limb movement; four experienced relief of spasms when the mirror was used to facilitate the unclenching of the phantom hand. Another participant’s pain disappeared with repeated use of the mirror over a three-week period. Participants reported that the visual image of the missing limb created a sensation of motion in the phantom limb. Three participants reported a relief of pain using the mirror image to “move” the phantom.

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Single Mirror

Despite the published success of treatment with single mirrors, many amputees experience no relief using a single mirror.  At this time, the rates of response are unknown, and the individual differences influencing mirror therapy are not well-understood.  In addition, there is some evidence that PLP is more common in below knee amputations. This may either be due to it initially being more likely to occur, or that PLP is more likely to resolve naturally in upper-limb amputations.

I have created a new mirror apparatus that has generated phantom sensations in nine pilot patients with limb loss. The new device uses three vertical mirrors, with panes oriented at angles. The tripartite mirror apparatus (TMA) enables viewers to see unusual multiple images of themselves from the side with the illusion of the missing limb intact. Two pilot patients (missing left arms) who reported their phantom hand in a painful, cramped, frozen position, felt movement, relaxation (unclenching of the phantom hand) and temporary relief of pain using the mirror image to “move” the phantom. One participant says, “When I am experiencing throbbing and stabbing feelings in my amputated arm and leg, I use the mirror.  It alleviates the pain and relaxes my phantom hand. I can then get on with what I am doing.” Another participant with a missing left arm experienced movement in his phantom limb for the first time in 18 years.  He reports feeling amazed at the sensation of his phantom hand moving and at seeing the illusion of his limb intact. A participant with a below knee amputation who reported perceptual telescoping (retraction of the phantom limb into the residual limb) experienced the lengthening of his phantom leg and a reduction in discomfort. This patient was emotionally overwhelmed by the sensation.

A common theme that emerges in response to mirror use is reports of phantom limb movement, relaxation (to a lesser degree) and pain relief. As a result of TMA use, all participants experienced phantom limb movement. A clinical trial has recently been completed with a cognitive behavioral intervention integrated with the TMA to treat phantom limb pain and psychosocial disability at the Veterans Administration Healthcare System. This data will provide further explanation of the TMA pilot study results.

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Tripartite Mirror Apparatus

The implications of the single mirror and TMA findings are that visual input (using the mirror) can reduce PLP. While most reports have used upper-limb loss patients, several case reports with lower-limb loss have also shown success in increasing perceived control over phantom limbs and reducing PLP.

Although at least 80 interventions exist to treat phantom limb pain, it is rarely treated successfully. For many sufferers, the ensuing chronic pain results in a decreased quality of life and an increased dependence upon costly medicines and medical resources. The potential efficacy of treating PLP with a single or tripartite mirror offers hope for finding a viable pain intervention.

For more mirror pictures you can read this article in InMotion magazine by clinking this link: http://www.amputee-coalition.org/inmotion_online/inmotion-22-06-web/#/1/

FOR INDIVIDUALS WITH LIMB LOSS, PLEASE CLICK ON  THIS LINK FOR RESOURCES AND SUPPORT FROM THE AMPUTEE COALITION http://www.amputee-coalition.org/

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Thank you for reading this article. I’m dedicating my personal and professional life to supporting people with limb loss.  My learning journey with chronic physical pain is a result of my personal experience with phantom limb pain.  I was graced with the gift of self-acceptance upon realization that my forearm was amputated.  As a result, I’ve learned a lot about what it takes to put an end to phantom limb and emotional pain.  And, as I learn and grow, I teach self-compassion and give advice I use myself, in the hopes that it helps you to improve your own life.

Roberta

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6 thoughts on “Mirror Therapy: Seeking Relief Through the Looking Glass

      • You are an amazing gift and blessing to the world, Roberta. Thank you for sharing and educating us on something so personal and intimate.

    • Thanks Leah,
      I believe I got to be an instrument in discovering this innovation for chronic pain. I tried the single mirror and it didn’t stop my pain. I was having a severe phantom pain episode one night and had the inspiration to use my bathroom mirror with folding mirror wings. The pain stopped and my phantom hand was released from a frozen clenched position. It has been 10 years pain free for me. Many amputees have life long chronic phantom pain episodes. I feel very fortunate.

      Roberta

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