Mirror, mirror on the wall
Can you help my pain, after all?
Well, that’s a version of the rhyme that never made it into Snow White! But if you’re looking for pain relief (instead of finding out who’s the fairest of them all :), mirror boxes might offer an answer.
Mirror image therapy is an exciting treatment for many pain syndromes. Today we’ll look at Complex Regional Pain Syndrome (CRPS), also called RSD.
CRPS is a neurological pain disorder with symptoms which include:
- pain out of proportion to any injury
- movement problems, e.g. muscle spasm, clumsiness
- temperature control problems, e.g. the affected area becomes cold or hot out of the blue, excessive sweating, pain increases with exposure to cold
There’s a lot that’s unknown about CRPS, but we do know that the changes that occur in CRPS affect not only the area where there’s pain, commonly a hand, foot, arm or leg. The changes also involve the spinal cord and brain.
The “body map” hypothesis we looked at last week may also apply to CRPS. This hypothesis says that there’s an internal representation of your body in your brain. This picture helps you know where your body is in space, even with your eyes shut. It also helps you perform movements, without having to think about each little part of a complex movement.
In CRPS, the brain’s map of the area where there’s pain may become distorted. It’s not clear if this distortion is a cause or a result of pain, but correcting this distortion can help.
In CRPS, movement often hurts and can make pain worse. But lack of movement means fewer normal sensations coming into the brain. This allows pain signals to get too much play in your brain, creating a sort of spiraling feedback loop…
pain, which causes… you to move less, which causes… fewer normal movement sensations going to your brain, which causes… pain signals have less to compete with to get your brain’s attention, which causes… PAIN, and we’re back to the beginning
So where do mirror boxes come in? Let’s say your right hand is affected by CRPS. You can put your right hand in the box so it’s not visible. You then move your left hand, and your brain “sees” the reflection as if your right hand is moving. And because your left unaffected hand is moving, the movements are easy and fluid. So it looks to your brain like you’re right hand’s moving comfortably and easily.
It may be that “tricking” your brain into seeing that everything’s ok, lets pain begin to slowly decrease.
Now for the “be careful” section…
- It gets trickier to use a mirror if…
- both your right and left side are affected, i.e. there’s no pain-free part
- an area like your chest, back, or stomach is affected, where there’s not an obvious mirror image part - It’s controversial if you can just start out using a mirror, or you need to build up to this kind of work, by graded motor therapy.
- It’s also controversial if you need to move the hand or foot that’s in the mirror box, i.e. the affected limb that’s hidden from view.
So… if you’re interested in mirror therapy, take a look at the websites below. Read some more on the treatment to educate yourself. And, most importantly, get some guidance from a medical practitioner – MD, physical therapist, etc. - who’s informed about this treatment. It’s a very exciting option – and one I want to make sure you use safely.
2 excellent websites where you can learn more, as well as purchase a mirror with instructions for use:
And after we get this pain taken care of, we’ll move on to warts on the nose :)…
In my next post, we’ll look a graded motor imagery computer program, Recognise.
9 responses so far ↓
jeisea // Jun 20, 2007 at 10:38 pm
As you will be aware by now, I have had and am right now having great success with mirror therapy. As you indicated some aspects of this treatment are still being considered.
Personally I have success using a mirror frequently but for very short periods, less than a minute. I never continue if I feel any discomfort in the “good” body part. I do not use a box but hide my painful body part behind any mirror to which you can stand side on, so good side is visible in the mirror and painful side is behind the mirror.
I believe there is good thinking behind the suggestion you used guided imagery before starting with the mirror. I also agree that expert advice is the best way to go. However if a person is unable to find a therapist who uses mirror therapy I would encourage them, as you have, to visit the above mentioned sites and seek information on guided imagery. I couldn’t find anyone who knew what to do here so I just gave it a go. I’ll be eternally glad I did. It’s not a miracle cure, one go fixes all. You need to repeat and repeat to retrain the brain, I think. This is my personal opinion and it works for me.
jeisea
HtCwP // Jun 21, 2007 at 5:45 am
Thanks for your response, Jeisesa. I also am concerned that people won’t be able to find trained therapists. The NOI group website does list some therapists, and people could call PT departments in their area to see if anyone uses this.
Anyone else used this? Let us know.
Judy // Nov 19, 2008 at 9:41 am
I am a physical therapist looking for research articles on the use of mirror box. can you point me to any?
How to Cope with Pain // Nov 22, 2008 at 5:20 pm
Judy, I’ll be posting in December about articles on this treatment, as well as finding a practitioner. Check back (or, even better, sign up for delivery of How to Cope with Pain, so you’re sure to get the info).
Deb // Feb 11, 2009 at 7:45 pm
I have CRPS in both legs and feet so how would I benefit from this? I am open to trying this or anything though at this point? I just signed up for your newsletter and am looking forward to recieving it weekly. Thank you,Deb
Charles // Feb 11, 2009 at 10:59 pm
How does this work (or does it) when both legs are affected from the knee to the toes? My wife, a retired RN has been reading about this in some of her magazines she still recieves and I showed her this article. She told me how it is working with our service men and women who have lost limbs but what about when one still has both limbs? After a radioscope was done on my right foot the report came back that there is some bone loss and swelling in the foot and I have pain with each step I take. I wear shorts for the first time in my 75 years of life since I had the right knee replaced which brought on the CRPS. It is still bad if I go outside when the wind is blowing or it is raining and I can not get into the above ground pool that was given to us. I built a frame out of 1 1/2 inch pvc pipe that keeps the covers off my leggs and because I have always slept on my back without moving while asleep, I can some times go 3 to 4 hours without getting up. However, my leggs are hurting so bad and it takes a bit before I can stand up and walk. I go to the store and walk around the whole store just because I do not want to lose the ability to walk. I can neither sit or stand for long periods of time for if I do, I find it hard to move my leggs. I was in a drug study and it turned out I was recieving the drug but it caused my red and whit cells to drop to the point they had to kick me out of the study for fear I would get an infection and die. It also caused my B12 to drop and after 2 years I am still seeing the specialist for this problem. I will not allow myself to get in the place where I have to use a wheelchair in order to get about.
How to Cope with Pain // Feb 12, 2009 at 10:20 am
Deb and Charles, good questions. Yes, it is possible to benefit from the theory behind these treatments, even when you have both-sided pain symptoms. However, it is trickier. You need to find someone who’s skilled is using these kinds of treatment, and you need to have a medical eval to get a specific diagnosis before starting these treatments, if that hasn’t been done.
I don’t usually start people with 2-sided symptoms on mirror work right away. First, I’d use “graded motor imagery” or “tactile discrimination training.”
serena // Feb 15, 2009 at 5:53 am
I live in Cape Town South Africa and looking for a PT in the area who uses this method.
How to Cope with Pain // Feb 15, 2009 at 10:39 am
Serena, you can check on the NOI Group website to see if there are registered practitioners in your area. You can also call PT offices and see if they are familiar with these treatments.
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