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Assessment of efficiency of mirror therapy in preventing phantom limb pain in patients undergoing below-knee amputation surgery—a randomized clinical trial

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Abstract

Purpose and objectives

Phantom limb pain (PLP) is a major cause of physical limitation and disability accounting for about 85% of amputated patients. Mirror therapy is used as a therapeutic modality for patients with phantom limb pain. Primary objective was to study the incidence of PLP at 6 months following below-knee amputation between the mirror therapy group and control group.

Methods

Patients posted for below-knee amputation surgery were randomized into two groups. Patients allocated to group M received mirror therapy in post-operative period. Two sessions of therapy were given per day for 7 days and each session lasted for 20 min. Patients who developed pain from the missing portion of the amputated limb were considered to have PLP. All patients were followed up for six months and the time of occurrence of PLP and intensity of the pain were recorded among other demographic factors.

Results

A total of 120 patients completed the study after recruitment. The demographic parameters were comparable between the two groups. Overall incidence of phantom limb pain was significantly higher in the control group (Group C) when compared to the mirror therapy (Group M) group [Group M = 7 (11.7%) vs Group C = 17 (28.3%); p = 0.022]. Intensity of PLP measured on the Numerical Rating Scale (NRS) was significantly lower at 3 months in Group M compared to Group C among patients who developed PLP [NRS − median (Inter quartile range): Group M 5 (4,5) vs Group C 6 (5,6); p 0.001].

Conclusion

Mirror therapy reduced the incidence of phantom limb pain when administered pre-emptively in patients undergoing amputation surgeries. The severity of the pain was also found to be lower at 3 months in patients who received pre-emptive mirror therapy.

Trial Registration

This prospective study was registered in the clinical trial registry of India. Trial Registration number: CTRI/2020/07/026488.

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Data availability

The datasets generated and analysed during this study are available from the corresponding author (Pankaj Kundra) on reasonable request.

References

  1. Rahimi A, Mousavi B, Soroush M, Masumi M, Montazeri A. Pain and health-related quality of life in war veterans with bilateral lower limb amputations. Trauma Mon. 2012;17:282–6.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ehde DM, Czerniecki JM, Smith DG, Campbell KM, Edwards WT, Jensen MP. Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation. Arch Phys Med Rehabil. 2000;81:1039–44.

    Article  CAS  PubMed  Google Scholar 

  3. Kern U, Busch V, Rockland M, Kohl M. Birklein F [Prevalence and risk factors of phantom limb pain and phantom limb sensations in Germany. A nationwide field survey]. Schmerz Berl Ger. 2009;23:479–88.

    Article  CAS  Google Scholar 

  4. Jensen TS, Krebs B, Nielsen J, Rasmussen P. Immediate and long-term phantom limb pain in amputees: incidence, clinical characteristics and relationship to pre-amputation limb pain. Pain. 1985;21:267–78.

    Article  PubMed  Google Scholar 

  5. Davidson JH, Khor KE, Jones LE. A cross-sectional study of post-amputation pain in upper and lower limb amputees, experience of a tertiary referral amputee clinic. Disabil Rehabil. 2010;32:1855–62.

    Article  PubMed  Google Scholar 

  6. Hirsh AT, Dillworth TM, Ehde DM, Jensen MP. Sex differences in pain and psychological functioning in persons with limb loss. J Pain. 2010;11:79–86.

    Article  PubMed  Google Scholar 

  7. Flor H, Nikolajsen L, Staehelin JT. Phantom limb pain: a case of maladaptive CNS plasticity? Nat Rev Neurosci. 2006;7:873–81.

    Article  CAS  PubMed  Google Scholar 

  8. Vaso A, Adahan H-M, Gjika A, Zahaj S, Zhurda T, Vyshka G. Peripheral nervous system origin of phantom limb pain. Pain. 2014;155:1384–91.

    Article  PubMed  Google Scholar 

  9. Costigan M, Scholz J, Woolf CJ. Neuropathic pain: a maladaptive response of the nervous system to damage. Annu Rev Neurosci. 2009;32:1–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Dickinson BD, Head CA, Gitlow S, Osbahr AJ. Maldynia: pathophysiology and management of neuropathic and maladaptive pain—a report of the AMA Council on Science and Public Health. Pain Med Malden Mass. 2010;11:1635–53.

    Article  Google Scholar 

  11. Ramachandran VS, Brang D, McGeoch PD. Dynamic reorganization of referred sensations by movements of phantom limbs. NeuroReport. 2010;21:727–30.

    Article  PubMed  Google Scholar 

  12. Dijkstra PU, Geertzen JHB, Stewart R, van der Schans CP. Phantom pain and risk factors: a multivariate analysis. J Pain Symptom Manage. 2002;24:578–85.

    Article  PubMed  Google Scholar 

  13. Limakatso K, Bedwell GJ, Madden VJ, Parker R. The prevalence and risk factors for phantom limb pain in people with amputations: a systematic review and meta-analysis. PLoS ONE. 2020;15: e0240431.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Hanley MA, Ehde DM, Campbell KM, Osborn B, Smith DG. Self-reported treatments used for lower-limb phantom pain: descriptive findings. Arch Phys Med Rehabil. 2006;87:270–7.

    Article  PubMed  Google Scholar 

  15. Subedi B, Grossberg GT. Phantom limb pain: mechanisms and treatment approaches. Pain Res Treat. 2011;2011: 864605.

    PubMed  PubMed Central  Google Scholar 

  16. Wittkopf PG, Johnson MI. Mirror therapy: a potential intervention for pain management. Rev Assoc Med Bras. 1992;2017(63):1000–5.

    Google Scholar 

  17. Kaur A, Guan Y. Phantom limb pain: a literature review. Chin J Traumatol Zhonghua Chuang Shang Za Zhi. 2018;21(6):366–8.

    Article  PubMed  Google Scholar 

  18. Brodie EE, Whyte A, Waller B. Increased motor control of a phantom leg in humans results from the visual feedback of a virtual leg. Neurosci Lett. 2003;341:167–9.

    Article  CAS  PubMed  Google Scholar 

  19. Giummarra MJ, Moseley GL. Phantom limb pain and bodily awareness: current concepts and future directions. Curr Opin Anaesthesiol. 2011;24:524–31.

    Article  PubMed  Google Scholar 

  20. Zheng B, Yin Y, Xiao H, Lui S, Wen C, Dai Y. Altered cortical reorganization and brain functional connectivity in phantom limb pain: a functional MRI study. Pain Pract. 2021;21(4):394–403.

    Article  PubMed  Google Scholar 

  21. MacIver K, Lloyd DM, Kelly S, Roberts N, Nurmikko T. Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery. Brain. 2008;131(8):2181–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Young RF, Chambi VI. Pain relief by electrical stimulation of the periaqueductal and periventricular gray matter. Evidence for a non-opioid mechanism. J Neurosurg. 1987;66:364–71.

    Article  CAS  PubMed  Google Scholar 

  23. Baron R. Mechanisms of disease: neuropathic pain—a clinical perspective. Nat Clin Pract Neurol. 2006;2:95–106.

    Article  PubMed  Google Scholar 

  24. Nandi D, Yianni J, Humphreys J, Wang S, O’sullivan V, Shepstone B. Phantom limb pain relieved with different modalities of central nervous system stimulation: a clinical and functional imaging case report of two patients. Neuromodulation J Int Neuromodulation Soc. 2004;7:176–83.

    Article  Google Scholar 

  25. MacLachlan M, McDonald D, Waloch J. Mirror treatment of lower limb phantom pain: a case study. Disabil Rehabil. 2004;26:901–4.

    Article  PubMed  Google Scholar 

  26. Corbett M, South E, Harden M, Eldabe S, Pereira E, Sedki I. Brain and spinal stimulation therapies for phantom limb pain: a systematic review. Health Technol Assess. 2018;22:1–94.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Anaesthesiology and Critical Care, Second Floor, Institute Block, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India

    Samatharman Purushothaman, Pankaj Kundra & Muthapillai Senthilnathan

  2. Department of Surgery, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India

    Sarath Chandra Sistla

  3. Department of Anaesthesiology, Manipal Hospital Whitefield, Bangalore, Karnataka, India

    Shathish Kumar

Authors
  1. Samatharman Purushothaman
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  2. Pankaj Kundra
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  3. Muthapillai Senthilnathan
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  4. Sarath Chandra Sistla
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  5. Shathish Kumar
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Contributions

SP: term, conceptualization, methodology, investigation, resources, data curation, writing-original draft, writing-review and editing, and data analysis. PK: term, conceptualization, methodology, investigation, resources, data curation, writing-original draft, writing-review and editing, and data analysis. MS: methodology, investigation, resources, data curation, writing-original draft, writing-review and editing, and data analysis. SCS: resources, data curation, writing-original draft, writing-review and editing, and data analysis. SK: resources, writing-original draft, writing-review and editing, and data analysis.

Corresponding author

Correspondence to Pankaj Kundra.

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Purushothaman, S., Kundra, P., Senthilnathan, M. et al. Assessment of efficiency of mirror therapy in preventing phantom limb pain in patients undergoing below-knee amputation surgery—a randomized clinical trial. J Anesth 37, 387–393 (2023). https://doi.org/10.1007/s00540-023-03173-9

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  • DOI: https://doi.org/10.1007/s00540-023-03173-9

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