Most amputees suffer from constant pain in the lost limb as a result of their injuries, an “irrational” type of pain that is difficult to endure. A recent study of landmine amputees in Cambodia showed that exercises for just five minutes a day and night in front of a mirror can offer a solution to this pain problem.
By Ha Sam Ol, Yang Van Heng and Hans Husum
Phantom pain is a common condition after limb amputation and often resistant to established treatment techniques. Recent studies of the central nervous system may explain why: After severe injuries, the image of the limb in the brain is distorted, with the lost limb represented by a larger than normal area of the brain cortex. It appears that normalization of these malformed patterns in the brain may relieve the pain.
A historical study
More than twenty years ago the Indian pain specialist Dr. Vilayanur S. Ramachandran claimed that mirror therapy reduced chronic pain arising in the brain after a stroke. The disabled limb was hidden behind a mirror, and reflections in the mirror of movements in the healthy limb provided an illusion of normality and approved function. Since then several reports have suggested that the treatment is also effective for phantom pain, but so far no scientific study had been undertaken.
Cambodia has suffered thirty years of war, and is among the top-ten countries with most landmine amputations. This tragic context made it possible to conduct for the first time a carefully controlled study of mirror treatment in a study population of 45 amputees. All of them were poor farmers, all with below knee amputations after landmine explosions. One third of the participants used mirror treatment each morning and night for four weeks, one third used desensitization therapy which exposed the painful limb to tactile stimuli, and one third used a combination of mirror and tactile therapy.
Visual feedback reorganizes the brain
The study, recently published in the Scandinavian Journal of Pain, demonstrated that all three interventions were associated with significant reductions of pain – both phantom limb pain as well as soreness in the amputation stump. The participants reported enthusiastically that they could endure harder manual work, could sleep at night for the first time, and re-establish a better family life.
Where the burden of poverty is heavy, there are wars and there are mine fields. It costs two dollars to make a simple mirror. The lessons from Cambodia are therefore especially relevant for amputees and health workers in low-resource communities worldwide.
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