Mirror box therapy added to cognitive behavioural therapy in three chronic complex regional pain syndrome type I patients: a pilot study

Tichelaar, Ynse Ieuwe Gerardus Vladimir; Geertzen, Jan H. B.; Keizer, Doeke; Wilgen, C.P. van

doi:10.1097/mrr.0b013e32813a2e4b

Cited by 63 publications

(15 citation statements)

References 17 publications

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“…Mirror visual feedback (MVF) as a possible therapy was first introduced in 1995 [1], and has since been used for the treatment of a variety of neurological disorders, including phantom limb pain [2], [3], stroke [4], pain related to spinal cord or nerve injuries [3], following wrist fracture [5], fibromyalgia [6], complex regional pain syndrome (CRPS) type 1 [7]–[11] and CRPS type 2 [12]. The main component of the MVF manipulation is a mirror vertically propped up in a position between two adjacently positioned boxes.…”

Section: Introductionmentioning

confidence: 99%

Referred Sensations Elicited by Video-Mediated Mirroring of Hands

2012

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Humans readily perceive ownership of a limb even when it is artificially induced as in the case of using a mirror reflection. However, mirror reflections are very constrained perceptions which do not allow transformations and varied contexts as often occurs in real life. The extent to which perceived limb ownership occurs with video-mediated manipulations is not known, particularly given the perception would no longer be a precise copy (reflection) of a person’s own limb. The present study directly compared referred sensations of the limbs with the use of a mirror reflection to those obtained with a new video-mediated setup to assess perceived ownership. Manipulations that could not be performed with a standard mirror reflection, such as reversal of the spatial positions of the limbs, were also investigated to examine how far the perceived ownership effects could be pushed. Across a series of experiments, data on the quality, intensity and location of referred sensations were collected and analyzed together with measures of hand ownership and participants’ experience of the two setups. Results reveal that participants felt referred sensations in both the optical and the video-mediated setup, and that video-mediated manipulations of hand-position reversals produced equal to stronger effects of ownership compared with the mirror reflection. These findings open up new possibilities for scientific experimentation and therapy that are discussed in the paper.

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Section: Introductionmentioning

confidence: 99%

Referred Sensations Elicited by Video-Mediated Mirroring of Hands

2012

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“…Mirror box therapy was initially introduced to treat phantom limb pain (Ramachandran et al 1995). For patients with CRPS, the treatment can enhance range of motion, and may also reduce pain in some patients (McCabe et al 2003b; Tichelaar et al 2007). The patient executes synchronous bimanual movements while viewing the reflection of the unaffected hand in a mirror placed in the sagittal midline.…”

Section: Introductionmentioning

confidence: 99%

Derangement of body representation in complex regional pain syndrome: report of a case treated with mirror and prisms

2009

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Perhaps the most intriguing disorders of body representation are those that are not due to primary disease of brain tissue. Strange and sometimes painful phantom limb sensations can result from loss of afference to the brain; and Complex Regional Pain Syndrome (CRPS)—the subject of the current report—can follow limb trauma without pathology of either the central or peripheral nervous system. This enigmatic and vexing condition follows relatively minor trauma, and can result in enduring misery and a useless limb. It manifests as severe pain, autonomic dysfunction, motor disability and ‘neglect-like’ symptoms with distorted body representation. For this special issue on body representation we describe the case of a patient suffering from CRPS, including symptoms suggesting a distorted representation of the affected limb. We report contrasting effects of mirror box therapy, as well as a new treatment—prism adaptation therapy—that provided sustained pain relief and reduced disability. The benefits were contingent upon adapting with the affected limb. Other novel observations suggest that: (1) pain may be a consequence, not the cause, of a disturbance of body representation that gives rise to the syndrome; (2) immobilisation, not pain, may precipitate this reorganisation of somatomotor circuits in susceptible individuals; and (3) limitation of voluntary movement is neither due to pain nor to weakness but, rather, to derangement of body representation which renders certain postures from the repertoire of hand movements inaccessible.

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“…These articles comprised one retrospective chart review [121], one prospective cohort [120], six case series [117,125,127,128,132,133], 14 clinical trials [109,111,112,119,122,123,126,131,135,138,140,146,147,150], two controlled clinical trials [130,136], 16 RCT's [108,113,114,116,124,129,134,137,139,141,143,145,146,148,149,152], four systematic reviews/meta analyses [110,115,142,144], and one treatment guideline [118]. Interventions evaluated therein were piroxicam [114], gabapentin [126], intrathecal baclofen [146], sympathetic blockade (lumbar, stellate ganglion and intravenous) (n = 5) [122,123,134,143,149], corticosteroids (n = 3) [114,119,135], calcium regulating medication (bisphosphonates, calcitonin) (n = 4) [110,116,138,142], NMDA antagonists (magnesium sulphate, ketamine, memantine) (n = 9) [111,121,125,131,140,146-148,152], free radical scavengers (mannitol, vitamin C) (n = 3) [129,135.137], nitric oxide regulating medication (n = 3) [133,141,151], spinal cord stimulation (n = 5) [112,115,120,128,132], regional anaesthesia (n = 2) [113,117], physiotherapy and rehabilitation medicine (physiotherapy, ...…”

Section: Discussionmentioning

confidence: 99%

Evidence based guidelines for complex regional pain syndrome type 1

et al. 2010

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BackgroundTreatment of complex regional pain syndrome type I (CRPS-I) is subject to discussion. The purpose of this study was to develop multidisciplinary guidelines for treatment of CRPS-I.MethodA multidisciplinary task force graded literature evaluating treatment effects for CRPS-I according to their strength of evidence, published between 1980 to June 2005. Treatment recommendations based on the literature findings were formulated and formally approved by all Dutch professional associations involved in CRPS-I treatment.ResultsFor pain treatment, the WHO analgesic ladder is advised with the exception of strong opioids. For neuropathic pain, anticonvulsants and tricyclic antidepressants may be considered. For inflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine) are advised. To promote peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used to increase blood flow in case vasodilatory medication has insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, vitamin C is recommended. Adequate perioperative analgesia, limitation of operating time, limited use of tourniquet, and use of regional anaesthetic techniques are recommended for secondary prevention of CRPS-I.ConclusionsBased on the literature identified and the extent of evidence found for therapeutic interventions for CRPS-I, we conclude that further research is needed into each of the therapeutic modalities discussed in the guidelines.

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Mirror box therapy added to cognitive behavioural therapy in three chronic complex regional pain syndrome type I patients: a pilot study

Cited by 63 publications

References 17 publications

Referred Sensations Elicited by Video-Mediated Mirroring of Hands

Referred Sensations Elicited by Video-Mediated Mirroring of Hands

Derangement of body representation in complex regional pain syndrome: report of a case treated with mirror and prisms

Evidence based guidelines for complex regional pain syndrome type 1

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