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Mirror Therapy's Potential to Treat Pain
Monday November 15, 2010


Most people consider mirrors invaluable when it comes to applying the perfect line of lipstick or preparing for the safest moment to change lanes, but a lesser-known use of mirrors is gaining momentum in the world of rehabilitation.

Two recent studies suggest that mirror therapy has the potential to help many patients who suffer from phantom limb pain. This simple, economical tool may also be effective when treating patients with complex regional pain syndrome and hemiparesis after a stroke.

“The concept of mirror therapy has been around since the mid-1990s, but there has been a lot of mystique around it and a lot of therapists don’t know about it,” says Beth Darnall, PhD, assistant professor of anesthesiology and perioperative medicine at Oregon Health & Science University, Portland. “I’m passionate about mirror therapy because it gives control back to patients and it has the potential to decrease their suffering.”

How it Works
Darnall, who recently completed a pilot study using mirror therapy for patients with phantom limb pain, became intrigued with the technique in 2007 when she treated a man with debilitating phantom pain. The 35-year-old patient had been struck by a drunk driver while walking. After the accident, he underwent an above-knee amputation of the left lower limb. His pain was so severe that he could not work. He had tried the traditional treatments, such as psychological counseling, relaxation techniques and pain medications, but nothing worked. Darnall decided to experiment with mirror therapy and showed the patient some simple exercises to do at home.

He bought a long mirror at a discount store and positioned it longitudinally against the coffee table in his living room while he sat on the floor. He positioned the intact leg in front of the mirror, and the amputated leg so it was hidden behind the mirror. The mirror reflected the intact leg so he would see a healthy leg and the image of a second healthy leg. By performing some simple movements with the healthy leg, his brain would encode the information that no amputation had occurred. He did this 20 minutes a day for several weeks.

“The brain has a body map, and when an amputation occurs, the cortical restructuring causes a distortion, which causes the sensation of pain,” Darnall says. “We are learning that what was previously thought of as permanent in the brain is not permanent at all. If we can retrain the brain, we can get phenomenal improvements, which is really exciting.”

Darnall began tracking the patient’s progress. After six weeks there was a significant reduction in pain, and within a few months the patient’s phantom limb pain was resolved. He returned to work and no longer needed pain medication.

“This got my attention because in the pain world, you don’t tend to see improvements like this,” Darnall says.

The patient’s results inspired Darnall to conduct a larger pilot study of self-delivered mirror therapy for phantom limb pain, and the abstract was published in the April issue of the Journal of Pain. About 79% of patients reported some reduction in pain. About 10% reported a 100% reduction in pain; about 21% reported a 50% reduction; almost half experienced roughly a 25% reduction; and 21% reported no improvement in pain.

“The participants had an average of 13 years of post-amputation pain, and they were just coping with it,” she says. “There are some pain medications they can use, but for the majority of people, they are not likely to completely resolve their pain with medication. They try relaxation therapy, surgery, acupuncture and other treatments, but they often experience mixed results.”

At Naval Medical Center San Diego, researchers are experimenting with using mirror therapy before an amputation to prevent pain after surgery. The researchers selected four service members who were at high risk of phantom pain because they had been suffering from significant pain before surgery. The participants performed daily mirror therapy starting two weeks before surgery and two weeks after surgery.

“The results were promising,” says Cmdr. Steven Hanling, MD, director of the NMCSD Pain Medicine Center. “All four could walk 1,000 feet unaided on a prosthetic shortly after surgery. These are high-risk patients for phantom pain, so it is unusual to be able to ambulate such distances unassisted after four weeks.”

Wider Applications
For Margaret McReynolds, PT, MEd, a physical therapist at Oregon Health & Science University, mirror therapy has shown promising results for a different group of patients: people who suffer from CRPS.

She remembers treating a woman who had suffered a gunshot wound to the right hand. The woman had tried desensitization, meditative breathing and a litany of other treatments, but she was still suffering from significant pain. She lived with pain for five years but was functional until she fell on her injured hand and the pain worsened. She no longer was able to use a knife, open doors or open her pill box. McReynolds decided to try mirror therapy. She asked the patient to perform basic tasks such as opening and closing the healthy hand in front of a mirror to give her brain the illusion of two healthy hands. The woman continued this therapy at home daily. McReynolds slowly made the tasks more complex, such as manipulating different textured balls, picking up clothes pins and pulling tape off a table.

After six weeks of mirror therapy, the woman’s pain decreased significantly and she could cut meat with a knife and open doors and pill boxes again. “It has been an amazing tool,” McReynolds says. “We want to help people have a better quality of life. When they can regain their life and it is being handed back to them, it is amazingly satisfying.”

Researchers are also beginning to explore the potential benefits for stroke patients, but more studies are needed to pinpoint which stroke patients are likely to see improvements.

“There is probably quite a bit of potential, but we really need research to help us do a better job of picking appropriate candidates for this type of therapy,” says Carolee Winstein, PT, PhD, FAPTA, professor of biokinesiology and physical therapy at the University of Southern California in Los Angeles.

Researchers such as Hanling are excited that something as simple as a mirror has the potential to alleviate suffering for some patients.

“It’s not a panacea,” Hanling says. “It’s a treatment option. The great thing about this is that there are zero side effects. It is a low-risk treatment that seems to be easy to teach and is fairly efficacious. That is what excites us about this therapy.” •

Heather Stringer is a freelance writer.

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Monday November 15, 2010
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