Observation of Limb Movements Reduces Phantom Limb Pain in Bilateral Amputees

Phantom limb pain (PLP) is an extremely common problem for individuals following the loss of a limb. Although the pathophysiology behind this sensation isn’t completely understood, there are treatments that have proven to provide patients with some relief. Currently, one of the most beneficial treatments for individuals with unilateral limb loss is mirror therapy.  The basic idea behind mirror therapy is that by observing the motion of their intact limb, they may visualize movement of their phantom limb and experience pain relief. This may work for unilateral amputees, but what about bilateral amputees? How can we help them?

A recent study published in ANNALS of Clinical and Translational Neurology by Tung and colleagues may have found a potential treatment option for this population. Their study included 20 male bilateral amputee patients with at least 3 episodes of phantom limb pain per week rating at least 3/10. Subjects were placed into 1 of 2 groups – either direct observation or mental visualization with 20 min treatments daily for one month. In the direct observation group, participants observed lower extremity movements and mimicked them with their phantom limb. In the mental visualization group, participants were asked to visualize themselves moving their phantom limb and feet. In order to measure improvements in PLP, this study used a 0-100 visual analog scale as well as the Short Form McGill Pain Questionnaire and asked subjects about episodes & duration of PLP since last visit.

Similar to studies for PLP relief in unilateral amputees, this study found visual treatments involving direct observation to be very effective in bilateral amputees. The direct observation group showed significant decreases in phantom limb pain on both the visual analog scale and Pain Questionnaire, whereas the mental visualization group showed no decreases in phantom limb pain on either outcome measure. Although we do not have a clear understanding of what the visual systems roll is in PLP relief, what is clear is that it should be incorporated into therapy for amputees!