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Has anyone used this work to treat phantom limb pain when a limb has been amputated? Obviously it would be mind/body pain, but when I was speaking with a physician yesterday to market my services, the topic of phantom limb pain came up. One of his nurses talked about an acquaintance who had to go through all sorts of physical/neuro therapies with mirrors etc. to retrain her brain. The physician with whom I spoke suggested I introduce myself to a couple of prosthetic company owners in town, but it occurred to me that I don’t remember it mentioned specifically in all my trainings and wonder if this work would still be indicated? I can’t think of why it wouldn’t be but wanted to make sure I’m not missing something given the types of therapies that were described.
Yes, all of these techniques apply to phantom limb pain. The mirrors are just another way of tricking the brain into believing things are ok. It can work, but so can these talk methods. Remember that pain is just the brain’s opinion of the state of things. If we can change the brain’s opinion then we can turn off the threat signaling which will stop the pain. The mirrors can teach the brain that it is safe too (through visual trickery/illusion).
That’s exactly what I was thinking, but just wanted to make sure I wasn’t missing something. Thank you!
To be honest, while mirrors can have a beneficial effect, I have not found them to be consistently beneficial. I have a colleague that worked a lot with mirrors related to CRPS, and he found that if the patient was not ready for that level of dissonant experience, the mirror could increase symptoms. In my practice, I have found better success engaging with the phantom limb with similar techniques to PRT vs the visual limb with mirror therapy. It has been easier for me to integrate that practice into their mobility (you cannot carry a mirror everywhere). One difficult aspect is that of healing time (which can be prolonged depending on the reason for the amputation and related to the adherence to wear schedules of their prosthesis if they have it yet) and the formation of neuromas at the residual limb/stump. It can create some difficulty in recognizing the differences between functional and structural symptoms. Chronic phantom limb pain (6-12 months out from the amputation) may be easier to identify as functional with less likelihood of other stuff getting in the way of addressing neural circuit issues.
Thank you so much, this is helpful. Would you recommend marketing these services to prosthetics providers then? Maybe with the caveat that PRT interventions would be most appropriate for those 6-12 months out from amputation?
Personally, I would market to them for sure as well as any trauma surgeons. I would not worry about giving any caveats. Some people have a faster healing response. Simple amputations can heal pretty quickly with complex trauma along with comorbidities such as diabetes and infection taking a much longer time. All of these people may benefit though. I was more trying to say what is easiest to differentiate. I took a look at the introductions page and see your are a psychologist. When I worked with a lot of people post amputation, I always worked to get them to psychotherapy services to process the trauma/grief more than what I have the time for as a physical therapist (I listen and coach but also have to assess their skin, gait, transfers, and other functional movements as well as education and training, which I work hard at trying to do some of these every session to decrease the likelihood of adverse problems. ). Plus, most PTs do not have the skill or mindset to work with people outside of pathoanatomical issues. It also can take a long time for some of these patients to commit to more treatment so hearing the option early and often in their recovery can be quite helpful. I hope that perspective helps!
I have treated a few people with phantom limb syndrome successfully using our model. I recall one incredible person and story: She had had 10 surgeries for ankle pain, including two fusions, two ankle replacements; all to no avail. Then she had an amputation below the knee of that leg to stop the pain, which didn’t stop the pain! I recall one time doing an EAET session with her with regard to childhood trauma and the pain disappeared on the spot.
She eventually recovered, but it took a while and she had a rocky course. Remind me to share with you a poem she wrote and a glass sculpture she created for me.
Best, Howard
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