Self-delivered home-based mirror therapy for lower limb phantom pain.

Darnall BD.  Self-delivered home-based mirror therapy for lower limb phantom pain. Am J Phys Med Rehabil. 2009 Jan;88(1):78-81.
This is a case study of a 35 year old man with an above-knee amputation of his left leg.  He noted phantom limb pain almost immediately after the injury, and continued to have symptoms despite completing rehabilitation and multidisciplinary pain management, and was consistently using pain medicine.  Prior to initiating mirror therapy, the patient reported a pain level of 4/10.  He was introduced to the concept of mirror therapy, as well as diaphragmatic breathing and progressive muscle relaxation.  He purchased a full-length mirror, which he placed on the floor opposite his intact limb.  He performed a self-designed program for 3 times a week for 30 minutes, which included multiple movements of the ankle, knee and hip.  He maintained a focus on viewing these movements in the mirror, and visualizing movement of his phantom limb.

He reported a consistent improvement in symptoms, and after increasing his frequency to daily performance, reported that his pain level decreased to 0/10, with no further need for pain medication.  He noted that he would have a return of symptoms if he did not perform his exercises for 1-2 days, but he was able to control this if he returned to regular performance.

Mirror therapy has been shown to be effective in hand and upper extremity treatment, but the same effects haven’t been shown in the lower extremity.  Some of the people I’ve spoken to hypothesize that this may be due to the significantly higher cortical representation of the hand, as one of the main effects of mirror therapy is thought to be changes in the cerebral cortex.  This case study demonstrates that in certain patients who have not had a satisfactory outcome with other appropriate pain-control measures, mirror therapy can have a significant effect on lower extremity phantom limb symptoms.  I especially liked the simplicity of this program, in that the subject bought his own inexpensive mirror, and was able to create his own program to control his symptoms.