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How Does Mirror Therapy Relieve Phantom Pain?

phantom limb patient

Many studies have shown mirror therapy to be effective in relieving phantom limb pain. However, the mechanism of how it works exactly is still unclear with a number of different theories.

The first theory was proposed by Ramachandran, who invented mirror therapy for phantom pain. He stated that phantom pain is felt as a result of a tensed phantom limb. He stated that because the limbs are not under voluntary control, they cannot become unclenched which is why the pain persists.

The phantom limb feels paralyzed because there is no feedback to the brain telling the brain it is not. Ramachandran and Rogers-Ramachandran believed that if the brain received visual feedback that the limb had moved, then the phantom limb would become unparalysed.

Using mirror therapy for phantom pain allows you to receive visual feedback that the phantom limb is relaxing and moving and therefore offers phantom pain relief. The visual information received by the brain overpowers the proprioceptive information and thus allows the brain to think the limb is moving. This is because the brain prioritises visual feedback over other senses. This model helps describe how mirror therapy can provide immediate pain relief for some patients with phantom limb pain as soon as they are able to move or unclench the limb.

Some other theories provide evidence for the long-term effects of phantom limb pain treatment with a mirror. It has been shown in amputees that pain is associated with reorganization of the primary sensory cortex contralateral to the amputated limb. Studies have found that the area where the hand would normally be represented in the brain shrinks, and is overtaken by representation for the face.

The degree of this reorganization correlates with the amount of pain experiences. A following study led by the same researcher found that reorganisation is partially reversed using mirror therapy and this corresponds with a reduction in pain. This would support the idea that using mirror therapy helps “rewire” the brain back to its normal state which helps decrease pain long term.

Harris (2000) suggested that phantom pain is caused by the discrepancy between what the brain is being told by the different senses. If the visual feedback from the mirror box matches the perception in the brain that the limb is there it may help reduce the pain.

Phantom pain mirror management allows you to independently manage your own pain. This improved control over the pain has been shown to increase self-efficacy and decrease anxiety. Mood is a strong factor in pain and normally if one improves, so does the other. The fact that phantom limb pain treatment with a mirror therapy can do both makes it a very effective technique.

Purchase the Mirror Therapy Box Rehab Kit For Phantom Limb Pain Here.

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References

Chan BL, Witt R, Charrow AP, Magee A, Howard R, Pasquina PF, (2007) Mirror therapy for phantom limb pain. N Engl J Med 357(21):2206–7.
Darnall BD. (2009) Self-delivered home-based mirror therapy for lower limb phantom pain. Am J Phys Med Rehabil 88(1):78–81.
Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumer N, LarbigW, Taub E (1995) Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 375:482-484,
Flor H, Diers M, Christmann C, Koeppe C. (2006) Mirror illusions of phantom hand movements brain activity mapped by fMRI. NeuroImage 31: S159.
Foell J, Bekrater-Bodmann R, Diers M, Flor H. (2014) Mirror therapy for phantom limb pain: brain changes and the role of body representation. Eur J Pain 18(5):729–39.
Gibson JJ. (1962) Observations on active touch. Psych Rev 69: 477–91.
Harris AJ. (2000) Cortical origin of pathological pain. Lancet 355: 318–9.
Moseley, GL; Gallace, A; Spence, C (2008), "Is mirror therapy all it is cracked up to be? Current evidence and future directions", PAIN 138 (1): 7–10
Ramachandran, VS & Rogers-Ramachandran, D. C. (1996), "Synaesthesia in phantom limbs induced with mirrors", Proceedings of the Royal Society of London (263(1369)): 377–386, doi:10.1098/rspb.1996.0058, PMID 8637922
Sumitani M, Miyauchi S, McCabe CS, Shibata M, Maeda, L, Saitoh Y, (2008) Mirror visual feedback alleviates deafferentation pain, depending on qualitative aspects of the pain: a preliminary report. Rheumatology (Oxford) 47(7):1038–43.
Yildirim, M & Kanan, N (2016) The effect of mirror therapy on the management of phantom limb pain Agri 28(3):127-134