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

Abstract

Background and 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 YR) participated in this study. 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 post-treatment scores for all SF-36 parameters (except for Role-Emotional) in favor of MT group (p<0.05). Conclusion: While pain intensity decreased and QoL and PS improved in both MT and PE groups, these improvements were greater in the MT group. Keywords: Mirror therapy, Phantom exercises, Phantom limb pain, Physiotherapy, Rehabilitation

Recent advances in understanding and managing phantom limb pain

“…Five RCTs examining the efficacy of MT for PLP have been published over the past 5 years 20, 21– 24 . Sample sizes range from a total of 15 20 to 60 23 .…”

“…Sample sizes range from a total of 15 20 to 60 23 . Two studies 21, 22 recruited unilateral lower extremity amputees only (n = 85), one study 20 recruited unilateral upper limb amputees only (n = 15), and the remaining two studies 23, 24 recruited both unilateral lower (n = 60) and unilateral upper (n = 17) extremity amputees. Time since amputation ranged from less than 1 month 20 to 32 years 22 ; one study 23 did not report time since amputation.…”

Body illusions for mental health: a systematic review

“…The reviewed studies in this systematic review also showed that the MBI had been widely used as an effective BOI toward a body part to reduce pain perception in patients with an amputation (Anaforoğlu Külünkoğlu et al, 2019;Chan et al, 2019;Darnall and Li, 2012;Diers et al, 2010;Finn et al, 2017;Kazemi et al, 2015;Ol et al, 2018;Ramadugu et al, 2017;Rothgangel et al, 2018;Tilak et al, 2016;Tung et al, 2014;Yildirim and Kanan, 2016). Indeed, the first clinical application of the MBI has been for pain relief in patients with phantom pain limb because of an amputation (Ramachandran et al, 1995).…”

“…Twenty-four studies used BIs to reduce pain perception in clinical populations (Alphonso et al, 2012;Anaforoğlu Külünkoğlu et al, 2019;Chan et al, 2019;Choi et al, 2019;Darnall & Li, 2012;Diers et al, 2010;Finn et al, 2017;Giummarra, Fitzgibbon, et al, 2010;Hwang et al, 2014;Kazemi et al, 2015;Lopez-Carballo et al, 2018;Louw et al, 2017;Matamala-gomez et al, 2018;Ol et al, 2018;Ortiz-Catalan et al, 2016;Osumi et al, 2019;Pamment & Aspell, 2017;Ramadugu et al, 2017;Reinersmann et al, 2013;Rothgangel et al, 2018;Themelis & Newport, 2018;Tilak et al, 2016;Tung et al, 2014;Yildirim & Kanan, 2016) (see table 3). Particularly, twelve studies used the MBI in amputee patients suffering from phantom pain limb (Anaforoğlu Külünkoğlu et al, 2019;Chan et al, 2019;Darnall & Li, 2012;Diers et al, 2010;Finn et al, 2017;Kazemi et al, 2015;Ol et al, 2018;Ramadugu et al, 2017;Rothgangel et al, 2018;Tilak et al, 2016;Tung et al, 2014;Yildirim & Kanan, 2016). One study used the MBI with patients with chronic stroke to decrease neck pain discomfort (Choi et ...…”

“…One randomized crossover study compared the use of the MBI with a conventional therapy for phantom pain relief in amputees (Ramadugu et al, 2017). Two studies conducted pilot experimental studies without control group to investigate the use of the MBI for phantom pain relief (Anaforoğlu Külünkoğlu et al, 2019;Yildirim & Kanan, 2016). Two pilot studies were directed to investigate the potential neural correlates of the MBI impact on pain relief, through brain responses in volunteers with unilateral leg amputation using functional magnetic resonance imaging (fMRI) during the course of mirror therapy (Chan et al, 2019), and comparing mirroring movements with imagined or executed movements (Diers et al, 2010).…”