Mirror therapy to reduce phantom limb pain. Systematic review

Authors

Keywords:

mirror therapy, pain, phantom limb

Abstract

Introduction: Phantom limb pain is a type of potentially debilitating neuropathic pain that affects 100 million amputees worldwide. The high prevalence, high levels of pain intensity, and associated decreased quality of life force us to explore new avenues to prevent, control, and reverse this condition. In this context, mirror therapy has recently been suggested.
Objective: To conduct a review on the effectiveness of mirror therapy to reduce phantom limb pain.
Method: A review was carried out following the PRISMA regulations. The databases of PubMed, Cinahl, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, CENTRAL, SciELO, and WOS were consulted.
Results: 71 studies were obtained. After eliminating duplicates and applying the inclusion criteria, 5 clinical trials remained. The sample was 250 patients. The duration of the program ranged from 1-4 weeks. All studies showed safety, and no major side effects occurred. Pain was assessed in all trials although different instruments were used: numerical pain intensity scale, visual analogue scale and brief pain inventory.
Conclusions: Mirror therapy is effective in reducing the incidence and intensity of phantom limb pain. This therapy reduces both phantom limb pain and stump pain, improving quality of life and psychological state. This is a method that patients can practice independently, improving self-control. It is safe, economical and easy to use.

Downloads

Download data is not yet available.

Author Biographies

Jesús Sánchez Lozano, Physiotherapy Clinic Policlínica Baza, Granada, Spain

Graduate in Nursing

Sandra Martínez Pizarro, Public Hospital of the Immaculate Conception, Almería, Spain

Nursing degree

References

1. Petersen BA, Nanivadekar AC, Chandrasekaran S, Fisher LE. Phantom limb pain: peripheral neuromodulatory and neuroprosthetic approaches to treatment. Muscle Nerve. 2019 Feb;59(2):154-167. doi: 10.1002/mus.26294.

2. Richardson C, Kulkarni J. A review of the management of phantom limb pain: challenges and solutions. J Pain Res. 2017 Aug 7;10:1861-1870. doi: 10.2147/JPR.S124664.

3. Urits I, Seifert D, Seats A, Giacomazzi S, Kipp M, Orhurhu V, et al. Treatment Strategies and Effective Management of Phantom Limb-Associated Pain. Curr Pain Headache Rep. 2019 Jul 29;23(9):64. doi: 10.1007/s11916-019-0802-0.

4. Modest JM, Raducha JE, Testa EJ, Eberson CP. Management of Post-Amputation Pain. R I Med J (2013). 2020 May 1;103(4):19-22.

5. Culp CJ, Abdi S. Current Understanding of Phantom Pain and its Treatment. Pain Physician. 2022 Oct;25(7):E941-E957.

6. Batsford S, Ryan CG, Martin DJ. Non-pharmacological conservative therapy for phantom limb pain: A systematic review of randomized controlled trials. Physiother Theory Pract. 2017 Mar;33(3):173-183. doi: 10.1080/09593985.2017.1288283.

7. Aternali A, Katz J. Recent advances in understanding and managing phantom limb pain. F1000Res. 2019 Jul 23;8:F1000 Faculty Rev-1167. doi: 10.12688/f1000research.19355.1.

8. Makin TR, Flor H. Brain (re)organisation following amputation: Implications for phantom limb pain. Neuroimage. 2020 Sep;218:116943. doi: 10.1016/j.neuroimage.2020.116943.

9. Schone HR, Baker CI, Katz J, Nikolajsen L, Limakatso K, Flor H, et al. Making sense of phantom limb pain. J Neurol Neurosurg Psychiatry. 2022 May 24;93(8):833-43. doi: 10.1136/jnnp-2021-328428.

10. Rothgangel A, Braun S, Winkens B, Beurskens A, Smeets R. Traditional and augmented reality mirror therapy for patients with chronic phantom limb pain (PACT study): results of a three-group, multicentre single-blind randomized controlled trial. Clin Rehabil. 2018 Dec;32(12):1591-1608. doi: 10.1177/0269215518785948.

11. Yang H, Yanagisawa T. Is Phantom Limb Awareness Necessary for the Treatment of Phantom Limb Pain? Neurol Med Chir (Tokyo). 2024 Mar 15;64(3):101-107. doi: 10.2176/jns-nmc.2023-0206.

12. Gunduz ME, Pacheco-Barrios K, Bonin Pinto C, Duarte D, Vélez FGS, Gianlorenco ACL, et al. Effects of Combined and Alone Transcranial Motor Cortex Stimulation and Mirror Therapy in Phantom Limb Pain: A Randomized Factorial Trial. Neurorehabil Neural Repair. 2021 Aug;35(8):704-716. doi: 10.1177/15459683211017509.

13. Barbin J, Seetha V, Casillas JM, Paysant J, Pérennou D. The effects of mirror therapy on pain and motor control of phantom limb in amputees: A systematic review. Ann Phys Rehabil Med. 2016 Sep;59(4):270-5. doi: 10.1016/j.rehab.2016.04.001.

14. Wang FY, Wang P, Wang Y, Kang YC, Zhu SJ, Wang HQ, et al. Randomized Controlled Trial of the Effects of Repetitive Transcranial Magnetic Stimulation and Mirror Therapy on Phantom Limb Pain in Amputees. 2022 May;53(3):474-480. doi: 10.12182/20220560209.

15. Herrador Colmenero L, Perez Marmol JM, Martí-García C, Querol Zaldivar MLÁ, Tapia Haro RM, Castro Sánchez AM, et al. Effectiveness of mirror therapy, motor imagery, and virtual feedback on phantom limb pain following amputation: A systematic review. Prosthet Orthot Int. 2018 Jun;42(3):288-298. doi: 10.1177/0309364617740230.

16. Guémann M, Olié E, Raquin L, Courtet P, Risch N. Effect of mirror therapy in the treatment of phantom limb pain in amputees: A systematic review of randomized placebo-controlled trials does not find any evidence of efficacy. Eur J Pain. 2023 Jan;27(1):3-13. doi: 10.1002/ejp.2035.

17. Scholl L, Schmidt A, Alfuth M. Efficacy of Mirror Therapy in Patients with Phantom Pain after Amputation of a Lower Limb: A Systematic Literature Review. Z Orthop Unfall. 2023 Nov 15. doi: 10.1055/a-2188-3565.

18. Wittkopf PG, Johnson MI. Mirror therapy: A potential intervention for pain management. Rev Assoc Med Bras (1992). 2017 Nov;63(11):1000-1005. doi: 10.1590/1806-9282.63.11.1000.

19. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. J Clin Epidemiol. marzo de 2021;19:26. doi: 10.1590/s0104-11692007000300023.

20. Mamédio C, Andrucioli M, Cuce M. The PICO strategy for the research question construction and evidence research. Rev Latino-Am Enfermagem 2007;15:508- 11. DOI: 10.1002/14651858.ED000142.

21. Higgins JPT, Thomas J. Cochrane Handbook for Systematic Reviews of Interventions. 2.aed. WILEY Blackwell; 2019. DOI: 10.1016/j.cireng.2013.08.002.

22. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. diciembre de 2016;5(1):210. DOI: 10.1186/s13643-016-0384-4.

23. Yıldırım M, Kanan N. The effect of mirror therapy on the management of phantom limb pain. Agri. 2016 Jul;28(3):127-134. doi: 10.5505/agri.2016.48343.

24. Ol HS, Van Heng Y, Danielsson L, Husum H. Mirror therapy for phantom limb and stump pain: a randomized controlled clinical trial in landmine amputees in Cambodia. Scand J Pain. 2018 Oct 25;18(4):603-610. doi: 10.1515/sjpain-2018-0042.

25. Anaforoğlu Külünkoğlu B, Erbahçeci F, Alkan A. A comparison of the effects of mirror therapy and phantom exercises on phantom limb pain. Turk J Med Sci. 2019 Feb 11;49(1):101-109. doi: 10.3906/sag-1712-166.

26. Purushothaman S, Kundra P, Senthilnathan M, Sistla SC, Kumar S. Assessment of efficiency of mirror therapy in preventing phantom limb pain in patients undergoing below-knee amputation surgery-a randomized clinical trial. J Anesth. 2023 Jun;37(3):387-393. doi: 10.1007/s00540-023- 03173-9.

27. Brunelli S, D'Auria L, Stefani A, Giglioni F, Mariani G, Ciccarello M, et al. Is mirror therapy associated with progressive muscle relaxation more effective than mirror therapy alone in reducing phantom limb pain in patients with lower limb amputation? Int J Rehabil Res. 2023 Jun 1;46(2):193- 198. doi: 10.1097/MRR.0000000000000582.

28. Xie HM, Zhang KX, Wang S, Wang N, Wang N, Li X, et al. Effectiveness of Mirror Therapy for Phantom Limb Pain: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2022 May;103(5):988-997. doi: 10.1016/j.apmr.2021.07.810.

29. Campo-Prieto P, Rodríguez-Fuentes G. Effectiveness of mirror therapy in phantom limb pain: a literature review. Neurologia (Engl Ed). 2022 Oct;37(8):668-681. doi: 10.1016/j.nrleng.2018.08.005.

30. Rajendram C, Ken-Dror G, Han T, Sharma P. Efficacy of mirror therapy and virtual reality therapy in alleviating phantom limb pain: a meta-analysis and systematic review. BMJ Mil Health. 2022 Apr;168(2):173-177. doi: 10.1136/bmjmilitary-2021-002018.

31. Wang F, Zhang R, Zhang J, Li D, Wang Y, Yang YH, et al. Effects of mirror therapy on phantom limb sensation and phantom limb pain in amputees: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2021 Dec;35(12):1710-1721. doi: 10.1177/02692155211027332.

Published

2025-01-15

How to Cite

1.
Sánchez Lozano J, Martínez Pizarro S. Mirror therapy to reduce phantom limb pain. Systematic review. Acta Méd Centro [Internet]. 2025 Jan. 15 [cited 2025 Jun. 29];19(1):e2033. Available from: https://revactamedicacentro.sld.cu/index.php/amc/article/view/e2033

Issue

Section

Review Articles