Abstract:

This study describes the use of Cognitive Behavioral Therapy (CBT) and a Tripartite Mirror Apparatus (TMA) as a novel approach to treating phantom limb pain. Phantom limb pain is commonly seen in amputees that have lost an arm or a leg due to reasons such as disease, combat, or trauma. Although it no longer exists, the "phantom limb" becomes the location of severe pain. The pain is typically described as "shooting," "stabbing," "squeezing," "throbbing," and "burning" (Ehde, et al., 2000; Flor, 2002; Montoya et al., 1997; Nikolajsen et al., 1997; Shreeve, 1993; Warten, Hamann & Wedley, 1997). The TMA is a three-panel mirror with multiple angles and reflections that induce an illusion in which observers view an image of him or herself from the side.

A repeated measures with-in subjects design was used with assessment instruments at baseline, start of treatment, posttest and an 8-week follow-up. Nine participants completed a 6-week course of CBT +TMA. The primary clinical hypothesis was that combined CBT+TMA treatment would produce pain reduction, reduction of psychological symptoms, improved functioning and improved quality of life.

The McGill Pain Questionnaire t -test scores were significant for the Sensory Pain Rating Index (S-PRI), t = 2.38, p = 0.049, pretest mean = 9.22, (SD = 7.51); posttest mean = 7.78, (SD = 9.24); follow-up mean = 5.37, (SD = 8.72).

On the Descriptor Differential Scale (DDS: Gracely & Kwilosz, 1988) there was a trend towards significance from pre-test to follow-up for improvement in DDS intensity. DDS sensory intensity pre-post and post-follow-up scores were t = 0.49, p = 0.64, pretest mean = 97.07, ( SD = 82.39); posttest mean = 82.39, ( SD = 57.41) and follow-up t = 0.54, p = 0.71, mean = 65.12, ( SD = 65.73).

During TMA practice participants' reported phantom limb movement, relaxation and pain relief. All participants had experienced a lack of movement of their phantom limb at baseline. Based on the findings of this feasibility study, it appears that the TMA may have a useful role in the management of PLP.