04/15/2013 // Concord, CA, USA // LifeCare123 // Greg A. Vigna, M.D., J.D. // (press release)

Medical Perspective:

Medical providers must weigh risk versus potential benefits for any intervention contemplated regarding the care of a patient. There are very few medical treatments available in all of medicine that are absolutely free of any risk of adverse effects on a patient. One such treatment is the use of mirror therapy, which is a proven effective treatment of phantom pain in an amputee. It is not only noninvasive but it is also very simple to provide in the context of prosthetic training of an amputee. This is important in that a majority of all upper and lower extremity amputees suffer with phantom pain. There is also evidence that mirror therapy may decrease the incidence in phantom pain in patients where it is employed prior to amputation.

There is extensive research in the mechanism of phantom pain and there continues to be significant debate. It has been well established that the mechanism of phantom pain involves both peripheral nervous system and the central nervous system including both the spinal cord and brain. Studies have shown that pain information that is transmitted up the spinal cord may be inhibited by stimulation of certain parts of the brain which turns off the ascending pain transmission up the spinal cord by transmitting inhibitory signals down the spinal cord. Following an amputation the brain will have lost the sensory stimulation from the amputated extremity and the intact brain starts to reorganize in a maladaptive fashion which can cause pain. It is believed that mirror therapy will stimulate the brain by way of the visual cortex which will trick the brain to believe that the amputated limb is still there which will decrease this maladaptive reorganization which will decrease the severity of the brain.

It has been proven that mirror therapy is easy to employ after an amputation and doesn’t actually require ongoing active physical therapy with a trained physical therapist to be effective. Essentially it requires education and commitment of the patient to dedicate 20 to 30 minutes a day with a mirror. The patient must understand that after the amputation the brain is essentially “confused” by the lack of input and will reorganize, sometimes in a fashion that may cause pain. By tricking the brain that the extremity is still there by way of the visual cortex this reorganization will be more adaptive and decrease the pain. A patient needs to “buy in” to this concept, sit down with a mirror and do simultaneous exercises with the intact extremity and the amputated extremity. Patients have essentially been able to wean themselves off of medications then eventually taper off their own self directed mirror therapy.

Life Care Planner Perspective:

It is a life care planner’s role to provide a road map for the care of these patients to maximize function, reduce or eliminate complications, and improve the individual’s quality of life going forward. All recommendations must be medically necessary, appropriate and should not be affected by cost and source of payment. In the case of an upper or lower extremity amputation a life care plan must include mirror therapy as a component of the postoperative physical rehabilitative therapy management program since it is both medically necessary and appropriate.

Media Information:

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