Thursday, February 19, 2009

A novel approach to pain management.

I've decided to contribute this post to How To Cope With Pain's February blog carnival.Click here to see what else is in this month's carnival.

By using a mirror image of a normal limb to convince the brain that everything is OK, V S Ramachandran, a United States Neurologist, in 1998, managed to relieve phantom limb pain.

Since then research has shown that Complex Regional Pain Syndrome and other chronic pains can be relieved by looking at the mirror image of the corresponding painful body part.

In Australia there is a great deal of interest, with mirror therapy becoming more widely accepted as treatment for chronic pain, in particular for the treatment of Complex Regional Pain Syndrome.

In 2004 thirteen chronic CRPS Type I patients were given two weeks each of a hand laterality recognition task, imagined hand movements and mirror therapy. The results upheld their hypothesis.

In 2006 at Oxford University in the UK, Dr Lorimer Moseley was involved in a much larger study . Their conclusion was that Motor Imagery using mirrors reduced pain and disability in patients with Complex Regional Pain Syndrome Type I or phantom limb pain, but the mechanism, or mechanisms, of the effect were not clear.

Dr Moseley and David Butler have written an excellent book which examines this novel approach to pain management, "Explain Pain". The Neuro-orthopeadic Institute of Australasia, NOI Group, was formed to support therapists here, in the USA and in Europe. If interested go to
the left of this blog and click on the link under crps/rsd related articles.

In the UK doctors, such as Dr Candy MacCabe of the University of Bath's School for Health, and Dr Ilan Lieberman, a Consultant Doctor specializing in Pain Medicine and Anesthesia at the University Hospital of South Manchester in England, have been able to alleviate the pain of Complex Regional Pain Syndrome using a simple mirror box.

In 2003 D MacCabe first described the use of this therapy for CRPS Type I. She showed that mirror visual feedback (MVF) relieved pain significantly, and normalized temperature changes in the affected limb.

In 2006 in the Nederlands a trial Treatment of Patients with Complex Regional Pain Syndrome Type I with Mirror Therapy is being conducted with the aim to improve arm-hand function. The hypothesis of this study is that mirror therapy stimulates cortical representation of the upper extremity. The functionality of the upper extremity is expected to improve more than with only conservative therapy.9-Sep-2005 - 7-Mar-2006

This 'cortical' model of pain suggests that the brain's image of the body can become faulty, resulting in a mismatch between the brain's movement control systems and its sensory systems, causing a person to experience pain when they move a particular hand, foot or limb.

Researchers believe that this kind of problem could be behind a host of pain-related disorders, such as complex regional pain syndrome and repetitive strain injury.

For more good evidence of the use of mirror therapy to alleviate pain and symptoms look to the left of this blog under "mirror therapy links" and for more of my posts on mirror therapy including photos, scroll down on the left of this blog and click on the tag "mirror therapy".


Anonymous said...

I don't know if that helps some people, but what if it is in both legs. The mirror would not only relieve pain, but only increase it. RSD is something that can not be controlled by looking in a mirror and guessing everything is okay. Otherwise, anorexia and bolemia would be cured.

Anonymous said...

Above "anonymous" is ignorant of what is being described. Try reading the book or talking to a professional who can explain it to you. No so simple as "looking in a mirror".

jeisea said...

The Australian research suggests a three step program. Google NOIGROUP. Here is a link to Recognize ap for hands which is recommended in preparation for mirror therapy.

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