Mirror Box Treatment For Phantom Limb Pain
Observations and Anecdotes
1. The technique is invariably more effective and dramatic when working with a phantom arm rather than the leg. Where there is a below-knee amputation, success is usually greater than with an above knee amputation.
2. Where sensory “remapping” occurs, i.e. stimulation to the corresponding cheek, neck and throat elicit sensation in the phantom hand/forearm, the mirror box approach is invariably successful. Where no remapping occurs, results are less significant. I have no idea why this should be the case.
3. Where the pain is caused by nerve pain or stump pain, the mirror box is of little benefit.
4. Therapists using the mirror box find it doesn’t work primarily for a very simple reason – they don’t set things up appropriately. For example, one chap with an amputation of left arm at shoulder level following brachial plexus injury had the problem that the phantom arm was twisted up behind his back. At this point, there is no value in using the mirror box. First, we had to manipulate the phantom into a position whereby it was in front of him so that it could be placed into the box. Another guy, having manipulated the phantom into the right position found no benefit from the mirror until we removed his wrist watch from his remaining wrist. The illusion needs to be total.
5. At the point the `effect` occurs with the mirror, there is usually an overwhelming release of emotion that is not unpleasant. After this initial effect, the person feels pleasantly different. This emotional state does not recur with subsequent sessions with the mirror box.
6. Success vastly increases where the client approaches the box with their remaining arm already in a mirror-position to that of the phantom. I think this is the problem that occurs when working with phantom legs, where often the phantom is a different length to that of the remaining limb.
I’d be interested to hear of any other experiences people have with the technique, both successful and otherwise. Eventually, I hope to collate the data and present it on the website in due course.