Mirror Image Therapy Shows Promise Relating to Phantom Limb Pain

Mirror image therapy has gained more attention in recent years, since its introduction was first reported by neuroscientist V. S. Ramachandran in 1996 as an alternative to more traditional and more costly measures of treatments and therapies.¹  Ramachandran’s methods were progressive for the time, as part of the beginning of what we now know as virtual reality and its unique role in physical therapy.  

Phantom sensations and pain may present themselves in many areas of the body, from the breast, nose, and other parts of the body, to internal regions including menstrual cramps following a hysterectomy.  Nonetheless, phantom limbs are the most commonly reported body parts associated with a “phantom” sensation following limb amputations after trauma, disease, or the like.²  The term “phantom pain” is a misnomer, however, as the pain is very real to the individual.

Mirror image therapy is used for treatment of loss of a full or partial limb when a patient still experiences pain or discomfort at the site of the injury or from the phantom limb itself.  This sensation is known as phantom limb pain and occurs in the majority of limb amputees.  The sensation can continue for patients for months or even years after loss of a limb.³  According to a literature review, “the phantom sensation is a common occurrence ranging from numbness, tickling, or muscle cramp in the non-existent limb and may be felt intermittently or permanently.”⁴  This sensation is higher in patients after traumatic limb loss when pain was already present at the site prior to amputation.⁵  Put simply, according to one study, everybody essentially has a map in his or her brain with signals pertaining to every area of the body, and that map does not disappear even though a person loses a limb.  Additionally, there may be residual nerves at the site of the lost limb.⁶

Many hypotheses have been proposed to account for the pain that develops in the phantom limbs of amputees.⁷  Some studies have suggested that mirror image therapy may be able to enhance the sense of agency over a phantom limb even if the pain is not necessarily relieved from therapy.⁸

So How Does It Work? 

Mirror image therapy is very easy to teach to patients, who then can practice the technique and seek relief at home.  A mirror is placed in-between the arms or legs of the patient, who concentrates on viewing the reflected movements of their intact limb while simultaneously “attempting to move the phantom limb” in a similar manner as the intact limb.  This method allows patients to see their anatomical limb in the visual space occupied by their phantom limb, ideally leading to improvement in control, and ultimately, pain relief.⁹  The goal for mirror image therapy is for the severed coherence between the brain’s motor command and sensory feedback to be enhanced.¹⁰  In other words, the visualization of  treating the intact limb is intended to close the gap in the brain and ignite relief from the perceived or experienced pain of the phantom limb. 

Consideration of mirror image therapy is significant, as treatment options for phantom limb pain are limited.  For instance, serious narcotics are often prescribed to deal with pain, which not only are costly but also may create problems for those with propensities for abuse or drug addiction.  Despite myriad issues with prescribing opioids to treat acute pain, in some instances, they remain one of the most common prescriptions to complement oral analgesics and regional anesthesia.¹¹

Recognition of mirror image therapy as a treatment option is important, as the therapy offers an alternate potential solution particularly for patients from low socioeconomic areas, thus improving access to care.  According to many studies, many individuals experienced improvement in level, duration, and incidence of pain.  Lessened pain also improves quality of life and increases an individual’s freedom of movement and activity, leading to social and professional reintegration.¹²

Notwithstanding, many current studies on the treatment lack methodological quality.  As legal advocates, this is important to recognize because a multi-disciplinary approach to advocacy may be crucial for more controlled studies in future years –  in particular to enhance the credibility of studies and increase the chance of establishing a cause-effect relationship.”¹³ Further, using a traditional mirror has its limitations, but increased capabilities with virtual reality systems provide newer, promising prospects.¹⁴ 

Overall, mirror therapy seems to be effective in alleviating phantom limb pain by controlling or minimizing symptoms, and it is a safe, simple, and inexpensive treatment that allows for self-help.  The option for mirror image therapy is an important consideration for all advocates of those in need of treatment, especially due to the correlation of other physical and mental health issues with individuals who suffer from chronic pain.

Sharon L. Genalen is an attorney with STG Divorce Law in Naperville. She can be contacted at sharon@stglaw.com.