New treatment for phantom limb pain

Dr. Jack Tsao, a Navy neurologist with the Uniform Services University, was looking for ways to help soldiers like Paupore. He remembered reading in graduate school a paper by Dr. V.S. Ramachandran that talked about an unusual treatment for amputees suffering “phantom limb pain,” using a simple $20 mirror.The mirror tricks the brain into “seeing” the amputated leg, overriding mismatched nerve signals.Here’s how it works: The patient sits on a flat surface with his or her remaining leg straight out and then puts a 6-foot mirror lengthwise facing the limb. The patient moves the leg, flexing it, and watches the movement in the mirror. The reflection creates the illusion of two legs moving together.

Paupore was one of the first to give it a try. At first, he was skeptical. When approached about joining a clinical trial at Walter Reed Army Medical Center to test Tsao’s theory, he declined. But sometimes his phantom pains were coming five to six times an hour and lasting up to a minute.

“I was laying in bed and it just, all of a sudden, it felt like I was getting shocked,” he said. “I called the nurse, ’cause I was like, ‘What’s going on?’ ” The nurse told him, “This is probably your phantom pain.”

Tsao explains it this way: “It’s the sensation that the limb is still present, and phantom pain in particular is the sensation that the limb is experiencing pain of some form.”

That pain is intense, and often medication brings very little relief. For Paupore, it was relentless.

“All of a sudden, it was like someone kept turning on and off the Taser, and my whole leg started twitching. … I sat up, and I was holding on to my stump, and it just wouldn’t stop. At that time, I was hooked up to the Dilaudid [a powerful narcotic], and I was pushing it. But you can push all the medicine in the world, and it won’t stop it.”

Paupore and 17 other amputees who joined Tsao’s mirror therapy trial were randomly assigned to one of three groups. The first group used the mirror to look at their reflected image as they tried to move both legs. The second group used a covered mirror and did the same. And members of the third group were asked to visualize moving their amputated limbs.

After a month of treatment, all of the patients in the mirror group had significantly less phantom pain. In the covered mirror group, only one patient experienced a decrease in pain, and for half of those patients, the pain worsened. Sixty-seven percent of the patients visualizing their limbs got worse instead of better. The pain decreased in almost 90 percent of the patients who then switched to mirror therapy.

It worked wonders for Paupore, 32. Within five months, he was off painkillers completely. Tsao says the difference is like night and day.

You can read this fascinating article in its entirety here.