Phantom limb pain and the mirror box: how does it work?
A phantom limb is the sense that an amputated part of the body is still there; when that sense is painful, it is called phantom limb pain. The mirror box uses a mirror to reflect your remaining hand or foot so the lost one appears to move, and it is used in rehabilitation. Results vary from person to person, so talk to your doctor before trying it.
Phantom limb and phantom limb pain: what is the difference?
After losing a hand or foot, some people still feel as though it is attached. They may reach out with the missing hand to break a fall, or feel an itch in a finger that is no longer there. This lingering sense of a lost body part is called a phantom limb.
When the sensation is painful, it is known as phantom limb pain. It is reported by a considerable number of people with limb loss. For some it fades over time; for others it lasts much longer.
| Phantom limb | Phantom limb pain | |
|---|---|---|
| What it is | Feeling that the lost part is still there | Pain felt in the lost part |
| Common examples | Reaching with the missing hand; itching | A frozen or paralysed feeling; pain that feels like the original injury |
| Over time | May fade by itself | May persist — worth discussing with a doctor |
Why can a missing limb still be felt?
The neuroscientist V. S. Ramachandran looked for the answer in the brain’s map of the body. Different areas of the brain handle sensation from different parts of the body. When amputation cuts off the signals from one part, the area that used to handle it may start responding to signals from a neighbouring part instead. This is possible because of neuroplasticity — the brain’s ability to rewire its connections in response to experience.
He reported that when he touched the cheek or lip of a man who had lost an arm, with the man’s eyes covered, the man felt the touch in specific parts of his missing hand. The explanation offered is that the brain areas for the hand and the face sit right next to each other.
How is the mirror box used?
Some phantom limb pain comes with a feeling that the missing limb is frozen or cramped. Ramachandran wondered whether showing the brain the limb moving could help release that feeling — and designed the mirror box.
- A lidless box is divided down the middle by a mirror.
- The remaining hand (or foot) goes into one side, while you imagine the missing one on the other side.
- Looking into the mirror from the side of the remaining hand, its reflection appears where the missing hand would be.
- As you slowly move the remaining hand, the missing one appears to move with it.
Among the cases he described is a man who had lost an arm in an accident and lived with pain in a phantom elbow. Watching the reflection, he felt the arm move — something he had not felt since the accident. Mirror therapy has since become known as one of the approaches tried in rehabilitation for phantom limb pain. It does not work the same way for everyone, however, and this article cannot promise any particular result.
Can anyone use it?
- You need a remaining limb to reflect — the method relies on a mirror image, so it is difficult for people who have lost both arms or both legs. Virtual reality approaches are being researched for these cases.
- Talk to your doctor beforehand — pain can have several causes, so the starting point is confirming whether it is phantom limb pain or something else.
How does this relate to a prosthesis?
How wearing a prosthesis affects phantom limb pain differs from person to person, and it is not something we can state with certainty. Silobionic does not provide pain management. Please decide when to be fitted together with your doctor, and do tell us about any sensations you have during your consultation — we will plan the fitting schedule and the way the prosthesis is worn around them.
Frequently asked questions
Does phantom limb pain go away on its own?
For some people it fades over time, but for others it lasts. If the pain continues, speak to your doctor.
Can I use a mirror box at home?
The set-up is simple, but it is wise to have a doctor or rehabilitation specialist confirm the cause of the pain and guide you beforehand.
What if I have lost both arms or both legs?
The mirror method is difficult in that case, but other approaches such as virtual reality are being researched. Ask your care team.
Will wearing a prosthesis reduce phantom limb pain?
It varies from person to person and cannot be predicted. We recommend deciding the timing of your fitting with your doctor.
