Assessment of efficiency of mirror therapy in preventing phantom limb pain in patients undergoing below-knee amputation surgery-a randomized clinical trial

Samatharman Purushothaman; Pankaj Kundra; Muthapillai Senthilnathan; Sarath Chandra Sistla; Shathish Kumar

doi:10.1007/s00540-023-03173-9

Assessment of efficiency of mirror therapy in preventing phantom limb pain in patients undergoing below-knee amputation surgery-a randomized clinical trial

J Anesth. 2023 Jun;37(3):387-393. doi: 10.1007/s00540-023-03173-9. Epub 2023 Feb 21.

Authors

Samatharman Purushothaman¹, Pankaj Kundra², Muthapillai Senthilnathan¹, Sarath Chandra Sistla³, Shathish Kumar⁴

Affiliations

¹ Department of Anaesthesiology and Critical Care, Second Floor, Institute Block, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
² Department of Anaesthesiology and Critical Care, Second Floor, Institute Block, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India. p_kundra@hotmail.com.
³ Department of Surgery, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India.
⁴ Department of Anaesthesiology, Manipal Hospital Whitefield, Bangalore, Karnataka, India.

PMID: 36809505
DOI: 10.1007/s00540-023-03173-9

Abstract

Purpose and objectives: Phantom limb pain (PLP) is a major cause of physical limitation and disability accounting for about 85% of amputated patients. Mirror therapy is used as a therapeutic modality for patients with phantom limb pain. Primary objective was to study the incidence of PLP at 6 months following below-knee amputation between the mirror therapy group and control group.

Methods: Patients posted for below-knee amputation surgery were randomized into two groups. Patients allocated to group M received mirror therapy in post-operative period. Two sessions of therapy were given per day for 7 days and each session lasted for 20 min. Patients who developed pain from the missing portion of the amputated limb were considered to have PLP. All patients were followed up for six months and the time of occurrence of PLP and intensity of the pain were recorded among other demographic factors.

Results: A total of 120 patients completed the study after recruitment. The demographic parameters were comparable between the two groups. Overall incidence of phantom limb pain was significantly higher in the control group (Group C) when compared to the mirror therapy (Group M) group [Group M = 7 (11.7%) vs Group C = 17 (28.3%); p = 0.022]. Intensity of PLP measured on the Numerical Rating Scale (NRS) was significantly lower at 3 months in Group M compared to Group C among patients who developed PLP [NRS - median (Inter quartile range): Group M 5 (4,5) vs Group C 6 (5,6); p 0.001].

Conclusion: Mirror therapy reduced the incidence of phantom limb pain when administered pre-emptively in patients undergoing amputation surgeries. The severity of the pain was also found to be lower at 3 months in patients who received pre-emptive mirror therapy.

Trial registration: This prospective study was registered in the clinical trial registry of India.

Trial registration number: CTRI/2020/07/026488.

Keywords: NRS score; Phantom Limb Pain; Phantom Limb Sensation; Preemptive Mirror Therapy.

Publication types

Randomized Controlled Trial

MeSH terms

Amputation, Surgical / adverse effects
Amputees*
Humans
Mirror Movement Therapy
Phantom Limb* / epidemiology
Phantom Limb* / prevention & control
Prospective Studies

Associated data

CTRI/CTRI/2020/07/026488