Mirror Therapy in Lower Limb Amputees – A Look Beyond Primary Motor Cortex Reorganization

Seidel, Stefan; Kasprian, Gregor; Furtner, Julia; Schöpf, Veronika; Essmeister, Maria; Sycha, Thomas; Auff, Eduard; Prayer, D.

doi:10.1055/s-0031-1281768

Cited by 28 publications

(46 citation statements)

References 30 publications

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“…In fact these results might extend to mental imagery and motor observation. For instance, imagination of amputated arm movements in chronic phantom pain can induce analgesic effects, which further supports our hypothesis and highlights the clinical relevance of the present findings [57], [58]. Seidel et al (2011) showed an average pain reduction of 2.8 in VAS after mirror visual feedback therapy in phantom limb pain.…”

Section: Discussionsupporting

confidence: 90%

“…Similarly Mercier et al (2009) showed a reduction in 38% in pain as indexed by VAS in phantom limb pain patients. [57], [58]. Nevertheless, it is important to underscore that the lack of changes in cortical excitability in motor learning task does not imply that simple movements are better than tasks with a learning component to modulate pain.…”

Section: Discussionmentioning

confidence: 99%

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Dissociation of Motor Task-Induced Cortical Excitability and Pain Perception Changes in Healthy Volunteers

et al. 2012

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Background There is evidence that interventions aiming at modulation of the motor cortex activity lead to pain reduction. In order to understand further the role of the motor cortex on pain modulation, we aimed to compare the behavioral (pressure pain threshold) and neurophysiological effects (transcranial magnetic stimulation (TMS) induced cortical excitability) across three different motor tasks. Methodology/Principal Findings Fifteen healthy male subjects were enrolled in this randomized, controlled, blinded, cross-over designed study. Three different tasks were tested including motor learning with and without visual feedback, and simple hand movements. Cortical excitability was assessed using single and paired-pulse TMS measures such as resting motor threshold (RMT), motor-evoked potential (MEP), intracortical facilitation (ICF), short intracortical inhibition (SICI), and cortical silent period (CSP). All tasks showed significant reduction in pain perception represented by an increase in pressure pain threshold compared to the control condition (untrained hand). ANOVA indicated a difference among the three tasks regarding motor cortex excitability change. There was a significant increase in motor cortex excitability (as indexed by MEP increase and CSP shortening) for the simple hand movements. Conclusions/Significance Although different motor tasks involving motor learning with and without visual feedback and simple hand movements appear to change pain perception similarly, it is likely that the neural mechanisms might not be the same as evidenced by differential effects in motor cortex excitability induced by these tasks. In addition, TMS-indexed motor excitability measures are not likely good markers to index the effects of motor-based tasks on pain perception in healthy subjects as other neural networks besides primary motor cortex might be involved with pain modulation during motor training.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Dissociation of Motor Task-Induced Cortical Excitability and Pain Perception Changes in Healthy Volunteers

et al. 2012

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“…In 14 patients with upper extremity amputation (7 with and 7 without PLP), Diers and colleagues demonstrated that patients without PLP had greater mirror-related activation in primary somatosensory and primary motor cortices during fMRI scanning [37]. However, in a recent fMRI treatment study by Seidel and colleagues [142], 12 sessions of mirror therapy in amputees with PLP were not associated with changes in mirror-related activation in the primary somatosensory and motor cortices, even though patients reported more than 50% mean improvement of pain. These results question whether sensorimotor reorganization underlies mirror therapy success or if it is a relevant precondition for pain relief.…”

Section: Neuroimaging Of Mirror Therapy In Pain Patientsmentioning

confidence: 99%

The use of functional neuroimaging to evaluate psychological and other non-pharmacological treatments for clinical pain

Jensen

Berna²,

Loggia

et al. 2012

Neuroscience Letters

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A large number of studies have provided evidence for the efficacy of psychological and other non-pharmacological interventions in the treatment of chronic pain. While these methods are increasingly used to treat pain, remarkably few studies focused on the exploration of their neural correlates. The aim of this article was to review the findings from neuroimaging studies that evaluated the neural response to distraction-based techniques, cognitive behavioral therapy (CBT), clinical hypnosis, mental imagery, physical therapy/exercise, biofeedback, and mirror therapy. To date, the results from studies that used neuroimaging to evaluate these methods have not been conclusive and the experimental methods have been suboptimal for assessing clinical pain. Still, several different psychological and non-pharmacological treatment modalities were associated with increased painrelated activations of executive cognitive brain regions, such as the ventral- and dorsolateral prefrontal cortex. There was also evidence for decreased pain-related activations in afferent pain regions and limbic structures. If future studies will address the technical and methodological challenges of today’s experiments, neuroimaging might have the potential of segregating the neural mechanisms of different treatment interventions and elucidate predictive and mediating factors for successful treatment outcomes. Evaluations of treatment-related brain changes (functional and structural) might also allow for sub-grouping of patients and help to develop individualized treatments.

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“…The literature search revealed 3 controlled clinical trials, 9 case series, 4 case reports, 4 treatment protocols, one narrative review, and one Delphi study …”

Section: Resultsmentioning

confidence: 99%

Development of a Clinical Framework for Mirror Therapy in Patients with Phantom Limb Pain: An Evidence‐based Practice Approach

et al. 2015

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Mirror Therapy in Lower Limb Amputees – A Look Beyond Primary Motor Cortex Reorganization

Cited by 28 publications

References 30 publications

Dissociation of Motor Task-Induced Cortical Excitability and Pain Perception Changes in Healthy Volunteers

Dissociation of Motor Task-Induced Cortical Excitability and Pain Perception Changes in Healthy Volunteers

The use of functional neuroimaging to evaluate psychological and other non-pharmacological treatments for clinical pain

Development of a Clinical Framework for Mirror Therapy in Patients with Phantom Limb Pain: An Evidence‐based Practice Approach

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