Comparison of Relative Benefits of Mirror Therapy and Mental Imagery in Phantom Limb Pain in Amputee Patients at a Tertiary Care Center

OBJECTIVE: To determine the relative benefit of mirror therapy and mental imagery in phantom limb pain. DESIGN: Prospective randomized controlled trial. SETTING: Physical Medicine and Rehabilitation Department, All India Institute of Medical Sciences, Patna. PARTICIPANTS: Amputees (N=92) with no significant difference in baseline characteristics. There was a male predominance in both groups (mirror therapy: 36 men, 10 women; mental imagery: 37 men, 9 women). INTERVENTION: Patients of both groups underwent a conventional amputee rehabilitation program and daily treatment of either mirror therapy or mental imagery on a regular basis, first in a rehabilitation care unit and later at home. MAIN OUTCOME MEASURES: Phantom limb pain (PLP) was measured by visual analog scale (VAS) score at baseline (0) and at 4, 8, and 12 months. RESULTS: This study included 92 patients ranging in age from 12 to 75 years (average, 34.79y). There was no significant difference in VAS score between the groups at baseline, but we found a significant reduction of pain in both groups at follow-up. However, upon comparing the improvement in both groups, we determined that the mirror therapy group had better improvement (from 7.07±1.74 to 2.74±0.77) compared with the mental imagery group (from 7.85±0.76 to 5.87±1.41). CONCLUSIONS: Mirror therapy and mental imagery are both good and cost-effective rehabilitation aids for amputee patients to reduce PLP, but mirror therapy appears to be more effective than mental imagery.