Mirror therapy: A potential intervention for pain management

Wittkopf, Priscilla Geraldine; Johnson, Mark I.

doi:10.1590/1806-9282.63.11.1000

Cited by 48 publications

(32 citation statements)

References 28 publications

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“…Our results are similar to previous studies that found synergistic effects of tDCS and mirror therapy in pain relief and increased quality of life in other clinical conditions (12,39,40). Recent studies have shown that tDCS application during mirror therapy promotes greater facilitation of corticospinal excitability and consequently enhances the effects of neuronal reorganization promoted by physical therapy (41,42).…”

Section: Discussionsupporting

confidence: 91%

Table_1.DOC

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Section: Discussionsupporting

confidence: 91%

Table_1.DOC

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“…In addition, previous studies suggested the use of tDCS as an approach to enhance or "boost" physical therapy (10,11). A commonly used form of rehabilitation is mirror therapy (MT), which involves a mirror being placed in a position that allows the patient to view a reflection of a body part (12). A growing body of evidence shows that the mirror creates visual feedback of what appears to be movement of the affected limb and this visual input might reduce the activity of systems that perceive protopathic pain (13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Transcranial Direct Current Stimulation and Mirror Therapy for Neuropathic Pain After Brachial Plexus Avulsion: A Randomized, Double-Blind, Controlled Pilot Study

et al. 2020

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Introduction: Although transcranial direct current stimulation (tDCS) and mirror therapy (MT) have benefits in combating chronic pain, there is still no evidence of the effects of the simultaneous application of these techniques in patients with neuropathic pain. This study aims to assess the efficacy of tDCS paired with MT in neuropathic pain after brachial plexus injury.Methods: In a sham controlled, double-blind, parallel-group design, 16 patients were randomized to receive active or sham tDCS administered during mirror therapy. Each patient received 12 treatment sessions, 30 min each, during a period of 4 weeks over M1 contralateral to the side of the injury. Outcome variables were evaluated at baseline and post-treatment using the McGill questionnaire, Brief Pain Inventory, and Medical Outcomes Study 36–Item Short-Form Health Survey. Long-term effects of treatment were evaluated at a 3-month follow-up.Results: An improvement in pain relief and quality of life were observed in both groups (p ≤ 0.05). However, active tDCS and mirror therapy resulted in greater improvements after the endpoint (p ≤ 0.02). No statistically significant differences in the outcome measures were identified among the groups at follow-up (p ≥ 0.12). A significant relationship was found between baseline pain intensity and outcome measures (p ≤ 0.04). Moreover, the results showed that state anxiety is closely linked to post-treatment pain relief (p ≤ 0.05).Conclusion: Active tDCS combined with mirror therapy has a short-term effect of pain relief, however, levels of pain and anxiety at the baseline should be considered.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT04385030.

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“…The persistent cortical representation of the missing limb and reassignment of brain areas, may explain why mirror therapy ( 42 ) is known as a promising tool for PLP management: volitive activation of cortex area of the phantom limb allows modulation and decreases thalamic processing ( 12 , 15 , 43 ). Mirror therapy studies showed that pain relief may be due to neuron firing when a person performs actions with the contralateral limb or observes someone's movements ( 44 ).…”

Section: Discussionmentioning

confidence: 99%

Intracortical Inhibition in the Affected Hemisphere in Limb Amputation

Santos

Gushken²,

Gadotti³

et al. 2020

Front. Neurol.

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Phantom limb pain (PLP) affects up to 80% of amputees. Despite the lack of consensus about the etiology and pathophysiology of phantom experiences, previous evidence pointed out the role of changes in motor cortex excitability as an important factor associated with amputation and PLP. In this systematic review, we investigated changes in intracortical inhibition as indexed by transcranial magnetic stimulation (TMS) in amputees and its relationship to pain. Four electronic databases were screened to identify studies using TMS to measure cortical inhibition, such as short intracortical inhibition (SICI), long intracortical inhibition (LICI) and cortical silent period (CSP). Seven articles were included and evaluated cortical excitability comparing the affected hemisphere with the non-affected hemisphere or with healthy controls. None of them correlated cortical disinhibition and clinical parameters, such as the presence or intensity of PLP. However, most studies showed decreased SICI in amputees affected hemisphere. These results highlight that although SICI seems to be changed in the affected hemisphere in amputees, most of the studies did not investigate its clinical correlation. Thus, the question of whether they are a valid diagnostic marker remains unanswered. Also, the results were highly variable for both measurements due to the heterogeneity of study designs and group comparisons in each study. Although these results underscore the role of inhibitory networks after amputation, more studies are needed to investigate the role of a decreased inhibitory drive in the motor cortex to the cause and maintenance of PLP.

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Mirror therapy: A potential intervention for pain management

Cited by 48 publications

References 28 publications

Table_1.DOC

Table_1.DOC

Transcranial Direct Current Stimulation and Mirror Therapy for Neuropathic Pain After Brachial Plexus Avulsion: A Randomized, Double-Blind, Controlled Pilot Study

Intracortical Inhibition in the Affected Hemisphere in Limb Amputation

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