Mind-Body Therapy- An Overlooked Treatment Following Amputation

Andrea Wakim, MS3

Photo by Polina Tankilevitch from Pexels

Pain experienced in a limb or tissue following amputation or nerve injury is known as phantom limb pain and is experienced by 60–80% of those with an amputation.1 This pain may be short-lived or chronic, and it has been described as burning and shooting to aching and throbbing.2 Though not fully understood, phantom limb pain is thought to be neurologic in origin from disruptions in the spinothalamic tract, dorsal root ganglion, peripheral nerves, and neurotransmitters and maladaptive plasticity/cortical reorganization.1,3,4,5,6 Given these proposed mechanisms and patients’ symptoms, chronic and neuropathic pain is a common treatment target.

Treatments for phantom limb pain are continuing to expand but commonly include tricyclic antidepressants, transcutaneous nerve stimulation, sympathectomy, nerve blocks, and stump manipulation in addition to various other modalities.7,8,9 However, many of these treatments have adverse side effects and are minimally effective.9 Accordingly, recent studies have investigated the possible role of mind-body therapy for phantom limb pain due to its complex nature.

Mind-body therapy focuses on the association between the brain and body. The goals of mind-body therapy are to increase self-awareness and understanding, in order to train the mind to influence overall health.9,10 Techniques used in mind-body therapy are vast, including hypnosis, tai chi, yoga, meditation, guided imagery, and biofeedback.9 Although research has not shown overwhelming efficacy of mind-body therapy, it has indicated it as a safe and relatively low-cost adjunctive therapy for patients. In studying patients with cancer-related neuropathic pain, mind-body therapy has been shown to be devoid side effects and influential in the experience and management of pain.11 Further, studies of chronic pain have shown that mind-body therapy may improve function and quality of life and decrease polypharmacy.12,13 The efficacy of mind-body interventions as a therapy has been attributed to its multifactorial nature, as it incorporates coping skills, stress management, and cognitive restructuring into relaxation therapy.14 This allows practitioners to modify their emotions and cognition, particularly in terms of pain perception due to the role of endogenous mechanisms in pain regulation.15,16

Given these positive effects, mind-body therapy may offer improvement in symptoms for those with phantom limb pain. Studies have shown that in those with chronic phantom limb pain, hypnosis therapy and imagery therapy have significantly reduced pain intensity and frequency and improved psychological function.17,18 Further, pain reduction has been shown at six months following hypnosis and image-guided therapies, and up to 12 months following biodfeedback.18,19,20 One study found that in those partaking in mental imagery training, significantly reduced phantom limb pain intensity was associated with reduced cortical reorganization, in regards to inappropriate activation, by fMRI.21 As cortical reorganization is a proposed mechanism of phantom limb pain, this data offers support and an area of potential continued investigation. A specific type of visual therapy that has been particularly successful in those with phantom limb pain has been mirror therapy. Mirror therapy has been shown to reduce phantom limb pain and offers the potential of minimizing medication use to manage pain.22,23,24

Overall, mind-body therapy has the potential to reduce chronic phantom limb pain. It positively benefits physical and mental aspects of health, thus necessitating the need for continued consideration and research of mind-body therapy. Though significant, standardized research needs to continue to be conducted to prove its efficacy, mind-body therapy is a treatment option that is safe, accessible, and beneficial to practitioners. Given this, mind-body therapy should be considered as an adjunctive treatment for those with amputation to minimize discomfort and maximize quality of life.

References:

1. Kaur A, Guan Y. Phantom limb pain: A literature review. Chin J Traumatol. 2018;21(6):366–368. doi:10.1016/j.cjtee.2018.04.006

2. Nikolajsen L, Jensen TS. Phantom limb pain. Br J Anaesth. 2001;87(1):107–116. doi:10.1093/bja/87.1.107

3. Lemons ML. Locate the Lesion: A Project-Based Learning Case that Stimulates Comprehension and Application of Neuroanatomy. J Undergrad Neurosci Educ. 2017;15(2):C7-C10.

4. Kajander KC, Wakisaka S, Bennett GJ. Spontaneous discharge originates in the dorsal root ganglion at the onset of a painful peripheral neuropathy in the rat. Neurosci Lett. 1992;138(2):225–228. doi:10.1016/0304–3940(92)90920–3

5. Koga K, Li S, Zhuo M. Metabotropic Glutamate Receptor Dependent Cortical Plasticity in Chronic Pain. Curr Neuropharmacol. 2016;14(5):427–434. doi:10.2174/1570159X13666150425002304

6. Flor H, Elbert T, Knecht S, et al. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature. 1995;375(6531):482–484. doi:10.1038/375482a0

7. Eija K, Tiina T, J N. Amitriptyline effectively relieves neuropathic pain following treatment of breast cancer. Pain. 1996;64(2):293–302. doi:10.1016/0304–3959(95)00138–7

8. What is the best way to manage phantom limb pain? J Fam Pract. 2009;58(3). Accessed May 22, 2020. https://www.mdedge.com/familymedicine/article/63500/pain/what-best-way-manage-phantom-limb-pain

9. Moura VL, Faurot KR, Gaylord SA, et al. Mind-Body Interventions for Treatment of Phantom Limb Pain in Persons with Amputation. Am J Phys Med Rehabil. 2012;91(8):701–714. doi:10.1097/PHM.0b013e3182466034

10. Complementary, Alternative, or Integrative Health: What’s In a Name? NCCIH. Accessed May 22, 2020. https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name

11. Cassileth BR, Keefe FJ. Integrative and behavioral approaches to the treatment of cancer-related neuropathic pain. The Oncologist. 2010;15 Suppl 2:19–23. doi:10.1634/theoncologist.2009-S504

12. Lee C, Crawford C, Hickey A. Mind–Body Therapies for the Self-Management of Chronic Pain Symptoms. Pain Med. 2014;15(S1):S21-S39. doi:10.1111/pme.12383

13. Morone NE, Greco CM. Mind–Body Interventions for Chronic Pain in Older Adults: A Structured Review. Pain Med. 2007;8(4):359–375. doi:10.1111/j.1526–4637.2007.00312.x

14. Astin JA. Mind-body therapies for the management of pain. Clin J Pain. 2004;20(1):27–32. doi:10.1097/00002508–200401000–00006

15. Rainville P. Brain mechanisms of pain affect and pain modulation. Curr Opin Neurobiol. 2002;12(2):195–204. doi:10.1016/s0959–4388(02)00313–6

16. Tindle HA, Wolsko P, Davis RB, Eisenberg DM, Phillips RS, McCarthy EP. Factors associated with the use of mind body therapies among United States adults with musculoskeletal pain. Complement Ther Med. 2005;13(3):155–164. doi:10.1016/j.ctim.2005.04.005

17. Oakley DA, Whitman LG, Halligan PW. Hypnotic imagery as a treatment for phantom limb pain: two case reports and a review. Clin Rehabil. 2002;16(4):368–377. doi:10.1191/0269215502cr507oa

18. Bamford C. A multifaceted approach to the treatment of phantom limb pain using hypnosis. Contemp Hypn. 2006;23(3):115–126. doi:10.1002/ch.316

19. Zuckweiler RL. Zuckweiler’s Image Imprinting in the Treatment of Phantom Pain: Case Reports. JPO J Prosthet Orthot. 2005;17(4):113–118.

20. Belleggia G, Birbaumer N. Treatment of phantom limb pain with combined EMG and thermal biofeedback: a case report. Appl Psychophysiol Biofeedback. 2001;26(2):141–146. doi:10.1023/a:1011391223713

21. MacIver K, Lloyd DM, Kelly S, Roberts N, Nurmikko T. Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery. Brain J Neurol. 2008;131(Pt 8):2181–2191. doi:10.1093/brain/awn124

22. Chan BL, Witt R, Charrow AP, et al. Mirror therapy for phantom limb pain. N Engl J Med. 2007;357(21):2206–2207. doi:10.1056/NEJMc071927

23. Mercier C, Sirigu A. Training with virtual visual feedback to alleviate phantom limb pain. Neurorehabil Neural Repair. 2009;23(6):587–594. doi:10.1177/1545968308328717

24. Wilcher DG, Chernev I, Yan K. Combined mirror visual and auditory feedback therapy for upper limb phantom pain: a case report. J Med Case Reports. 2011;5:41. doi:10.1186/1752–1947–5–41

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