“The More Input for the Brain, the Less Phantom Pain“ – Philipp Stude about the Mirror Therapy

People looking into the mirror are not necessarily vain. Perhaps they are just doing a therapy against phantom pain. A look into the mirror can trick the uncontrollable aches after amputations in a seemingly easy way. The neurologist Philipp Stude at the University Hospital Bergmannsheil in Bochum, Germany, is conducting a research on this therapy. In the interview on REHACARE.de he explains how it functions.

01.02.2009

Simple but effective - tricking the
phantom pain with a mirror
© Bergmannsheil

REHACARE.de: Mr. Stude, the mirror therapy can ease phantom pain. In your study you examine how this can function and you look into the brain of affected people.
Doctor Philipp Stude: Yes, we want to show the neuro-physiological bases of the therapy scientifically. This means the study is examining the changes after the treatment with the help of detailed records of the electric activities in the brain from the first therapy session on.

REHACARE.de: What have you found out up to now?
Stude: We could show that already within the first session changes which alleviate the pain can occur in the affected regions in the brain. Moreover, our investigations show that some patients respond very well to the mirror therapy, others less. That is because one needs some imagination and motivation. And this again also depends on the constitution of the patients whether they are having pain or if they are concentrated enough. By now, we do not know it exactly.

REHACARE.de: How does a mirror therapy session proceed?
Stude: The patient is sitting in front of a mirror which is standing in the body middle, so that it shows a reflexion of the healthy limb. Thus the patient sees his healthy limb and the reflexion in place of the amputated one. When making motor exercises with his healthy arm for example, it looks as if he was moving his amputated arm.

REHACARE.de: And how can this ease the ache?
Stude: The brain plays a big role in phantom pain. Each body part is represented in a region of the brain. Nowadays researchers assume that this region starts shrinking when no more signals reach it after the amputation – this is called the shrink effect and causes pain again. The mirror therapy starts there because the patient perceives the moving extremity as the amputated hand. The visual signal provides the information for the brain that the lost limb is doing something and this stimulates the shrunken cerebral region. The more input for the brain, the less phantom pain.

REHACARE.de: What is the advantage of the mirror therapy?
Stude: The mirror therapy is a treatment without drugs and intervenes where the pain originates. It fights against the origin and not only the symptoms. Moreover, it does not have side effects like feeling sick or tired. A young man which had lost his arm in the middle of the upper arm and had been suffering from very strong phantom pain lost his sudden pain attacks within two days. Thereby he could discontinue a very high morphine dose. Nevertheless, he still needs some other medications. He takes low measured anticonvulsants and an antidepressant. In general, the mirror therapy is to be seen as a supplement to the medical treatment. It will not substitute it.

REHACARE.de: Does this therapy also have side effects?
Stude: Even the mirror therapy can have side effects. One wants to feel the phantom, the amputated extremity. If this succeeds, however, it can also happen that increasing pains and feelings develop like cold, warmth or prickle. This can happen in all treatments which work with imagination. Just at the beginning of the treatment this occurs in about ten percent of the patients. In the worst case one must stop the therapy.

REHACARE.de: Can one make the exercises at home as well?
Stude: Actually, one has to practice at home, so that the effect remains. After ten to twelve sessions the patients can do it on their own. 30 to 60 minutes every day. And they do it with pleasure because they see that they reach aims which they would never reach only by the help of drugs.

REHACARE.de: And how long does the therapy work?
Stude: Up to now one knows that it works for a period of six months. To find out whether the treatment also works for a long time we would like to carry out another study over more than four years.

The interview was conducted by Natascha Mörs.
REHACARE.de