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Complex Regional Pain Syndrome (CRPS) – Can Mirrors Help?

June 20th, 2007 · 23 Comments

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…

  1. 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
  2. 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.
  3. 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:

Noi Group
Mirror Box Therapy

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.


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23 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.

  • Ellen // Jul 23, 2010 at 8:32 am

    After i slipped on a wet hardwood floor, and cracked just above my Ankle on the doorframe as i fell, I have had terrible pain, especially at the sight of the injury, but also in other areas of my Foot/Leg.
    Plus my leg just below the knee to the foot has changed colour, to mottled Red/mauve.
    I had a MRS scan, to see the damage the fall had caused, but the specialist i was sent to couldnt open the cd disc the report came back on. he said looking at my leg i had probably got CRPS through the injury, and he wouldnt be able to operate on any injury in any case.
    I live alone, can hardly walk without crutches, and if i do put my body weight on my foot/leg, i suffer even more pain that usual.
    I feel so alone with this, as the consultant just discharged me, saying theres nothing he cn do
    my GP sent me to see a ( supposedly) dermatologist, to look at the skin changes in my leg,,she wasnt long out of Uni, and hadnt even seen anyone with CRPS, let alone able to help me.
    I just want to know if i will be able to walk around again, and scared this will spread.
    Ellen

  • How to Cope with Pain // Jul 23, 2010 at 4:22 pm

    Ellen, as you might imagine, we can’t give medical advice or predictions online. What we’d recommend is to see a pain specialist asap so you can be evaluated, diagnoses, and treated appropriately. If you do have RSD (CRPS), treatment is available for that, so I don’t agree with the “nothing can be done” response you’ve received.
    Good luck!

  • Jeff // Jan 2, 2012 at 8:15 pm

    I broke my ankle badly on Labor day 2011. I had to wait to have surgery because of the swelling and pain. I continued to have severe pain (off and on and randomly) after surgery and it was 8 weeks before my surgeon diagnosed RSD. I started mirror therapy with a PT where I live (Augusta, Maine) after I had read about it on this site. It has worked for me but it doesn’t seem to last for long. I am hoping that continued therapy (I do it on my own at home like jeisea) will ‘retrain’ my brain. I have tried alot of things but have the most hope with the mirror therapy. My foot is still purplish in color and swells quite a bit but the pain is the most noticeable. It comes and goes randomly; can be very intense at times; other times is quite managable; no rhyme or reason that I can tell. I use it (my foot) as much as possible whether it hurts or not because I don’t want it to atrophy. I believe in the power of the mind so I feel it will get better over time. Best wishes to all dealing with this. It can be very frustrating!

  • How to Cope with Pain // Jan 3, 2012 at 8:04 am

    Jeff, I’m glad to hear that you were diagnosed fairly quickly and got started right away with brain re-training. Sorry you’re still having CRPS symptoms, though!

    A few thoughts I have:
    1. If symptoms come back soon after going away with mirror therapy, it can sometimes mean there is still an underlying un-healed problem. Has your doctor said everything has healed correctly? I assume x-rays have been taken to be sure nothing is still uncorrected.
    2. You might try adding the Recognise program, in addition to using mirrors. This would be another brain re-training modality to use, to see if additional exercises could help.

    Let us know how you make out!

  • Dr Francois Nel // Mar 4, 2012 at 1:02 am

    If you live in SA there may be a cure for your
    RSD/CRPS pain. Read on the net about Ketamine treatment, either weekly IV treatment or medically induced coma. It is done in South Africa.
    You can be helped!!!!!!!!

  • Dr Francois Nel // Mar 4, 2012 at 1:05 am

    Please, please, NO surgery, your pain will only get worse.

  • Chris de Jager // Mar 13, 2012 at 2:19 pm

    Dear Dr. Francois Nel

    Please provide me with contact details in South Africa for ketamine treatments….thank you

  • Adriana Byars // Apr 6, 2012 at 4:00 pm

    I have CRPS and I am also drealing with L&I in the process. I am having an almost impossible time coping with my pain. what can I ask them to do to help me that they wil actually pay for?!?

  • Julie // Apr 28, 2012 at 7:13 pm

    I would like to purchase a mirror box for use with my clients. Sources? Thanks

  • How to Cope with Pain // Apr 28, 2012 at 8:41 pm

    Julie, 2 excellent websites where you can learn more, as well as purchase a mirror with instructions for use:
    Noi Group

    Mirror Box Therapy

  • elizabeth // May 16, 2012 at 9:01 pm

    i just started mirror box therepy ,i have crps in my rt shoulder,i have no pain in my shoulder while doing the mirror therepy i do experience the same crawling sensations in it and the tingling but to have no pain for 10 minutes while doing the treatment feels awsome !i will continue to use this treatment at home i am hoping over time this will give me less pain !

  • Chantel Nel // Nov 13, 2012 at 2:44 pm

    My daughter Francesca was diagnosed in May this year and are on epileptin and dixarit.she has alot of pain and is only 8 years old she was given morphine twice due to severity of the pain.

  • Jeff // Jan 7, 2013 at 6:13 pm

    I was diagnosed with Dystonia and RSD/CRPS Type II I totally blew out a disk in my back that intruded into my spine when 2 surgeries were done it had left me with nerve damage before the surgeries I had massive mussel spasms and loss of movement to my legs I have gone through physical therapy every year till my insurance is maxed on it I have stopped taking drugs because of the over dosing the doctors were doing to me I am working and I am in loads of pain not only do I have dystonia in my left leg from the knee down but also a frozen foot in one position my hips hurt badly as well. As well as my knees.. I have lost over 3 inches of mussel in my left leg compared to my right my whole body weight is mostly carried on my right leg and foot now doctors are saying that this mirror therapy will work as well as to reading a book on pain they guarantee me that It will be all fixed and normal with in a months time of doing this in therapy I think some one is looking at my reports wrong because another doctor says it wont help due to nerve damage and the dystonia in the leg so I don’t know what to do

  • How to Cope with Pain // Jan 7, 2013 at 7:04 pm

    Jeff, chronic pain is often part “local”, meaning a local injury that continues to cause pain, and part “stuck in the brain”. However, it often impossible to tell, for any patient, what part is “local” and what part is “stuck in the brain.’ If you have RSD/CRPS, to me that means at least some of it is in your brain. This is the part of the pain that mirror therapy could potentially help with. Some of the newer treatment modalities such as mirror therapy could potentially help with dystonia too. In my opinion, it would definitely be worth having at least an evaluation by someone who does “brain re-training”, including mirror therapy.

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