Mirror therapy shows promise for amputees' phantom pain
Entering the treatment room at Temple University Hospital, Arnold Carlton looked at the mirror placed along the floor and had the usual reaction.
Entering the treatment room at Temple University Hospital, Arnold Carlton looked at the mirror placed along the floor and had the usual reaction.
"I said, 'That's not going to work,' " Carlton recalled recently, sitting in a wheelchair in the visitor lounge with the stump of his amputated left leg propped up on the seat. "I never heard of anybody doing that."
Eric Altschuler, an associate professor of physical medicine and rehabilitation at the hospital, was used to the skepticism. He quickly moved the 55-year-old North Philadelphia man through a series of exercises in the mirror in which he moved his right leg back and forth.
"It was weird at first," Carlton said. "It's like you've got both your legs."
What was even weirder, though, was the fading of the pain in what had been his left leg.
Carlton, whose leg was amputated in November due to complications from diabetes, was suffering from "phantom pain," a common ailment that is the worst of possible worlds for an amputee: You don't have the limb but it still hurts, emitting a sharp, throbbing sensation that often defies drugs and conventional physical therapy. It occurs in more than 80 percent of amputees and in other traumatic injuries, as well.
In so-called mirror therapy, the patient views a reflection of the healthy limb where the injured limb would be. The patient "sees" the injured limb moving at the same time.
No one knows exactly why it works to reduce pain and increase mobility, but some clinical trials - and the experiences of patients like Carlton - indicate it often does. "It makes physical therapy a lot better," Carlton said. "I'm pain-free when I'm doing it."
And in a trial starting this winter at the Walter Reed National Military Medical Center, Altschuler hopes to find that mirror therapy also can help patients with complex battlefield injuries involving multiple joints, muscles, or nerves in the same limb.
The experiment at Walter Reed will involve 15 to 30 minutes of therapy five or six days a week over eight weeks. Most of it will be done at the hospital, but patients can go through the exercises at home and continue normally for a period after release.
"If it works for the hardest one, it will probably work for the easiest ones," Altschuler said. "The soldiers are often the worst. We take people who've plateaued for one or two months."
Mirror therapy was pioneered in the mid-1990s by Vilayanur Ramachandran, a neuroscientist at the University of California, San Diego, where Altschuler was one of his students.
In a study published in 2007 in the New England Journal of Medicine, Jack Tsao, formerly at Walter Reed and now a professor of neurology at the University of Tennessee Science Center, and other researchers found that mirror therapy is effective for treating phantom limb pain.
A subsequent study using functional magnetic resonance imaging has found that amputees using mirror therapy show changes in brain activity. "We think we may have a brain marker" for phantom pain, he said.
Tsao, a former director of traumatic brain injury programs for the U.S. Navy Bureau of Medicine and Surgery, says it is impossible to estimate the number of veterans and other amputees who could be helped if the use of mirror therapy can be expanded.
"It would clearly broaden our treatment options," he said, particularly in cases of wounds from bullets and explosives. He added that virtually all types of injuries that happen on the battlefield also are sometimes seen in civilian life.
Altschuler says, however, that he is motivated to work with wounded veterans for more than purely medical reasons.
"They're our wars," he said. "They're on our watch."