The Efficacy of Movement Representation Techniques for Treatment of Limb Pain—A Systematic Review and Meta-Analysis

Thieme, Holm; Morkisch, Nadine; Rietz, Christian; Dohle, Christian; Borgetto, Bernhard

doi:10.1016/j.jpain.2015.10.015

Cited by 111 publications

(111 citation statements)

References 52 publications

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“…Because congenital one-handers show lip remapping but do not experience phantom pain, our results provide a counter-example to the maladaptive plasticity theory of phantom pain. This and other recent evidence showing typical somatotopy in amputees [15, 28, 29] suggest that the maladaptive plasticity theory should be reconsidered, as well as therapeutic approaches derived from it (e.g., mirror therapy [30]).…”

Section: Discussionmentioning

confidence: 79%

Representation of Multiple Body Parts in the Missing-Hand Territory of Congenital One-Handers

et al. 2017

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SummaryIndividuals born without one hand (congenital one-handers) provide a unique model for understanding the relationship between focal reorganization in the sensorimotor cortex and everyday behavior. We previously reported that the missing hand’s territory of one-handers becomes utilized by its cortical neighbor (residual arm representation), depending on residual arm usage in daily life to substitute for the missing hand’s function [1, 2]. However, the repertoire of compensatory behaviors may involve utilization of other body parts that do not cortically neighbor the hand territory. Accordingly, the pattern of brain reorganization may be more extensive [3]. Here we studied unconstrained compensatory strategies under ecological conditions in one-handers, as well as changes in activation, connectivity, and neurochemical profile in their missing hand’s cortical territory. We found that compensatory behaviors in one-handers involved multiple body parts (residual arm, lips, and feet). This diversified compensatory profile was associated with large-scale cortical reorganization, regardless of cortical proximity to the hand territory. Representations of those body parts used to substitute hand function all mapped onto the cortical territory of the missing hand, as evidenced by task-based and resting-state fMRI. The missing-hand territory also exhibited reduced GABA levels, suggesting a reduction in connectional selectivity to enable the expression of diverse cortical inputs. Because the same body parts used for compensatory purposes are those showing increased representation in the missing hand’s territory, we suggest that the typical hand territory may not necessarily represent the hand per se, but rather any other body part that shares the functionality of the missing hand [4].

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Section: Discussionmentioning

confidence: 79%

Representation of Multiple Body Parts in the Missing-Hand Territory of Congenital One-Handers

et al. 2017

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“…For example, mirror therapy and motor imagery are effective in the treatment of pain and disability associated with complex regional pain syndrome type I and type II 156 . The quality of evidence supporting these interventions for neuropathic pain is weak and needs further investigation 154,157 .…”

Section: Managementmentioning

confidence: 99%

Neuropathic pain

Colloca

Ludman

Bouhassira

et al. 2017

Nat Rev Dis Primers

1,566

1,364

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Neuropathic pain is caused by a lesion or disease of the somatosensory system, including peripheral fibres (Aβ, Aδ and C fibres) and central neurons, and affects 7–10% of the general population. Multiple causes of neuropathic pain have been described and its incidence is likely to increase owing to the ageing global population, increased incidence of diabetes mellitus and improved survival from cancer after chemotherapy. Indeed, imbalances between excitatory and inhibitory somatosensory signalling, alterations in ion channels and variability in the way that pain messages are modulated in the central nervous system all have been implicated in neuropathic pain. The burden of chronic neuropathic pain seems to be related to the complexity of neuropathic symptoms, poor outcomes and difficult treatment decisions. Importantly, quality of life is impaired in patients with neuropathic pain owing to increased drug prescriptions and visits to health care providers, as well as the morbidity from the pain itself and the inciting disease. Despite challenges, progress in the understanding of the pathophysiology of neuropathic pain is spurring the development of new diagnostic procedures and personalized interventions, which emphasize the need for a multidisciplinary approach to the management of neuropathic pain.

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“…Studies have shown variable success rates of MT for PLP 12–14 . Better effects were noted when MT was used to treat deep somatic pain, pressure, and proprioception than to treat superficial pain, and temperature sensitivity; this is due to the fact that deep tissues integrate sensorimotor nerves and create movements, while superficial tissues do not.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, although MT has been used for the past 2 decades in adults, no firm conclusion can be drawn regarding its effects for PLP in adults, 12,14 furthermore, its efficacy has yet to be evaluated in children, adolescents, and young adults. The goal of this retrospective study was to describe the differences between pediatric patients who received MT in addition to the standard therapy for PLP (MT group) and those who received only the standard therapy (non-MT group) at our institution.…”

Section: Introductionmentioning

confidence: 99%

Mirror Therapy for Phantom Limb Pain at a Pediatric Oncology Institution

Anghelescu

Kelly

Steen

et al. 2016

Rehabilitation Oncology

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Background and Purpose/Objective Mirror therapy has not been reported for phantom limb pain (PLP) in pediatric oncology. Our aims are to describe the incidence and duration of PLP post-amputation, the duration of follow-up, pain scores and pain medications, and the differences between a group that received mirror therapy (MT) in addition to the standard treatment and a group that received only the standard treatment (non-MT). Methods A retrospective review of patients’ medical records from June 2009 to March 2015 was completed. The demographic characteristics, diagnoses and types of surgery were collected. The incidence and duration of PLP, duration of pain service follow-up, pain medications and pain scores were collected and analyzed using the Wilcoxon rank sum test. Results Of 21 patients who underwent amputations (median age 13 years, range, 8–24 years), most common primary diagnosis osteosarcoma), 18 (85.7%) experienced PLP; 38.9% of them experienced PLP at 1 year post-amputation (11.1% of the MT group and 66.7% of the non-MT group). The MT group and non-MT groups experienced PLP for a mean (± SD) of 246 (± 200) days, and 541 (± 363) days, respectively (p=0.08). The mean (SD) opioid doses (mg/kg/day) in the MT and non-MT groups were 0.81 (± 0.99) and 0.33 (± 0.31), respectively; the mean (SD) gabapentin doses (mg/kg/day) were 40.1 (± 21) for the MT group and 30.5 (± 11.5) for the non-MT group. Conclusion MT in children with cancer-related amputations is associated with lower incidence of PLP at 1 year and shorter duration of PLP.

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The Efficacy of Movement Representation Techniques for Treatment of Limb Pain—A Systematic Review and Meta-Analysis

Cited by 111 publications

References 52 publications

Representation of Multiple Body Parts in the Missing-Hand Territory of Congenital One-Handers

Representation of Multiple Body Parts in the Missing-Hand Territory of Congenital One-Handers

Neuropathic pain

Mirror Therapy for Phantom Limb Pain at a Pediatric Oncology Institution

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