Mirror Therapy for Phantom Limb Pain Treatment in Military Amputees

Over 1500 U.S. military service members have undergone major limb amputations due to injuries sustained in Iraq or Afghanistan. Recent research indicates that up to 90% of these wounded warriors have or will experience phantom limb pain (PLP): the perception of pain in a missing limb. PLP can be a crippling complication of limb loss, with pain described as “knife-like”, “searing”, and “burning” among other descriptors. Despite the high prevalence of PLP among amputees, there is currently no standard treatment for the condition. In most cases, patients are prescribed methadone, pregabalin, or other pain medications as a first line treatment for PLP. These medications are costly (approximately $50 for one month’s supply), are associated with a number of negative side effects, and are often ineffective. Mirror therapy, on the other hand, avoids the negative side-effects and steep costs inherent to most drug therapies. Mirror therapy has been shown in a randomized clinical trial conducted at the former Walter Reed Army Medical Center to effectively relieve PLP. For this treatment, a mirror is placed between the intact and amputated extremity, reflecting the intact limb to give the illusion of two healthy and movable limbs. A $5-$20 mirror, once purchased and used to treat PLP, amounts to a potential $600/year cost savings per patient.

Because of the low costs, minimal side effects, and efficacy of mirror therapy, we propose changing the initial treatment for phantom pain in the military healthcare system from medications to mirror therapy. This move would bring treatment in line with clinical research findings on PLP therapies. The only costs associated with the treatment are for mirrors and clinician time (although mirror therapy can also be self-administered). This treatment innovation could be easily implemented, requiring only the training of physical and occupational therapists, patients, and the acquisition of mirrors. If successful, the idea could easily be translated to the entire Military Health System through educating clinicians and patients on how to administer mirror therapy. The idea would furthermore be Tri-service, as deployed members of the Army, Navy, and Air Force are at risk for sustaining amputation(s), and can be scaled to all of DoD, VA, then nationwide and possibly worldwide .

A small pilot study would verify the benefits and reduced costs of initially treating PLP with mirror therapy instead of pharmaceutical drugs. Supplying one rehabilitation center with mirrors, briefly training clinicians on how to administer mirror therapy, and tracking cost savings from discontinuing pain medications would amount to less than $500 total. One pilot location would be sufficient, provided that the facility treated enough patients to determine the feasibility of using mirror therapy as the first line treatment for PLP. Furthermore, the idea could be implemented within a matter of weeks, as the only necessary steps would be acquisition of the materials (mirrors) and training of the clinical team on mirror therapy. The widespread implementation of mirror therapy holds promise for relieving wounded warriors from pharmaceutical side-effects and crippling phantom limb pain.

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