Mirror Therapy for Phantom Limb Pain at a Pediatric Oncology Institution

Abstract

Background and Purpose/Objective Mirror therapy has not been reported for phantom limb pain (PLP) in pediatric oncology. Our aims are to describe the incidence and duration of PLP post-amputation, the duration of follow-up, pain scores and pain medications, and the differences between a group that received mirror therapy (MT) in addition to the standard treatment and a group that received only the standard treatment (non-MT). Methods A retrospective review of patients’ medical records from June 2009 to March 2015 was completed. The demographic characteristics, diagnoses and types of surgery were collected. The incidence and duration of PLP, duration of pain service follow-up, pain medications and pain scores were collected and analyzed using the Wilcoxon rank sum test. Results Of 21 patients who underwent amputations (median age 13 years, range, 8–24 years), most common primary diagnosis osteosarcoma), 18 (85.7%) experienced PLP; 38.9% of them experienced PLP at 1 year post-amputation (11.1% of the MT group and 66.7% of the non-MT group). The MT group and non-MT groups experienced PLP for a mean (± SD) of 246 (± 200) days, and 541 (± 363) days, respectively (p=0.08). The mean (SD) opioid doses (mg/kg/day) in the MT and non-MT groups were 0.81 (± 0.99) and 0.33 (± 0.31), respectively; the mean (SD) gabapentin doses (mg/kg/day) were 40.1 (± 21) for the MT group and 30.5 (± 11.5) for the non-MT group. Conclusion MT in children with cancer-related amputations is associated with lower incidence of PLP at 1 year and shorter duration of PLP.

The effect of visual feedback of body parts on pain perception: A systematic review of clinical and experimental studies

“…Two studies could not be included in the meta‐analysis. A study using 15 amputees with PLP showed no significant pain reduction comparing mirror VF using a normal‐sized reflection with no treatment (SMD = −0.08; 95% CI = −1.10, 0.93, (Anghelescu et al., ). The study including six amputees with PLP showed that the combination of mirror VF using a normal‐sized reflection with synchronized stroking of the stump and the hand in front of the mirror significantly reduced pain compared with only mirror VF using a normal‐sized reflection (SMD = −1.58, 95% CI = −2.50, −0.66, (Schmalzl et al., ).…”

Phantom Limb Pain in Pediatric Oncology

“…At this time, no one medication is standard of practice, but several modalities have demonstrated benefits. In pediatric and pediatric oncology reports, medication utilization is similar to adult reports, with most authors reporting some combination of medications for treatment ( 8 , 11 , 12 ).…”

“…For congenitally related amputations, the prevalence of PLP has been noted to be lower, between 3.7 and 20% of children, even occurring in children with congenital absence of a limb ( 4 , 10 ). In the pediatric oncology population, the prevalence of PLP is also wide ranging between 48 and 90% ( 5 , 7 , 11 , 12 ). The onset of pediatric PLP typically occurs shortly after amputation, most often within the first week after amputation ( 5 , 7 ).…”

“…In older studies (1995 and 1998), retrospective surveys have found PLP (of all etiologies) to last years after amputation ( 4 , 5 ). More recently in 2012 and 2016, only 10–38.9% of pediatric oncology patients reported PLP at 1-year follow-up ( 11 , 12 ). This difference in duration of PLP is potentially explained by the evolution of preventative and therapeutic measures now available, as discussed in more detail below ( 11 ).…”

“…Two adult randomized placebo-controlled trials demonstrated mixed results for the efficacy of gabapentin in reducing PLP, with both studies demonstrating reduced pain intensity but only one study being statistically different than placebo ( 24 , 25 ). No randomized controlled studies of gabapentin have been performed with pediatric patients; however, several case reports in pediatric cancer document its potential clinical use in isolation or in combination with other therapies ( 11 , 12 , 26 ). In a 2001 case series, gabapentin helped alleviate PLP in three of three pediatric patients at doses 20–35 mg/kg, with pain relief coming suddenly when the therapeutic dose was achieved ( 26 ).…”