Mirrors helping amputees fight phantom pain

But it isn’t a new drug, researched at the cost of millions of dollars, or a complicated, computer-driven gizmo.

It’s a mirror, four feet long and a foot wide.

“I think it cost us $20 at Linens & Things,” said Navy Cmdr. Jack Tsao, an associate professor of neurology at the Uniformed Services University of the Health Sciences in Bethesda, Md.

That simple mirror is proving effective at relieving phantom limb pain — the puzzling, frustrating, often unbearable sensation an amputated limb is still attached to the body that plagues up to half of all amputees.

Scientists don’t know for sure why people have phantom pain, Tsao said, but in very basic terms, the brain is sending electronic signals to a limb that’s no longer there. The mismatch between what the brain thinks is there and what really exists somehow causes pain.

With the wars in Iraq and Afghanistan growing the population of military amputees, Tsao began looking into ways to treat phantom pain starting in 2005.

As part of his research, he recalled seeing studies by Vilayanur Ramachandran, a neuroscientist at the University of California, San Diego.

In the mid-1990s, Ramachandran developed the theory that mirrors could be used to trick the mind into “seeing” the missing limb, and thus reprogramming itself in such a way that the neurons would stop misfiring and causing pain or discomfort.

But Ramachandran lacked both the money to conduct expensive clinical field trials, and more importantly, a large enough pool of amputees to test his idea, Tsao said.

At Walter Reed, however, Tsao had the money and the test subjects.

Beginning last summer, the Navy doctor set up clinical trials with 18 volunteer amputees.

The results “astounded me,” he said.

Participants in the trial used the mirror therapy technique 15 minutes a day, five days a week for four weeks.

Every single person who used the mirror experienced relief, and some reported that their phantom pain disappeared.

“I didn’t expect [the results] to be that good,” he said.

Neither did Army Sgt. Nicholas Paupore, a 101st Airborne Division artilleryman, one of the participants.

“I thought it sounded crazy,” he said when approached last July. “I almost said ‘no.’ But the [phantom] pain was driving me insane, so if it worked even a little, it would be worth it.”

Paupore, 32, had been wounded in Kirkuk, Iraq, on July 2 when six explosively formed penetrators ripped through his Humvee.

His first experience with phantom pain was in Germany at Landstuhl Regional Medical Center, where Army doctors had amputated his shattered right leg below the knee.

Alone in his quiet hospital room, the wounded soldier had been floating with his eyes closed, lost in a drug-induced fog.

Suddenly, a searing shock raced from the sole of his missing foot up the back of his nonexisting calf and into his thigh.

“I felt like I was getting Tasered,” he said. “It was like sticking my finger in a light socket.”

Paupore grabbed the rails of his hospital bed, pulled himself bolt upright, screamed and dry-heaved.

From that point forward, the phantom pain came and went with maddening randomness. Sometimes it hit him five times an hour. Sometimes several hours passed with no problems, Paupore said.

The only predictable thing about Paupore’s phantom pain, he said, was the intensity.

“It interferes with all aspects of your life,” he said. “It drove me bonkers.”

His doctors put him on methadone, a narcotic analgesic; as well as Neurontin, a medicine used to treat nerve pain.

But the drugs were only dulling Paupore’s reaction, he said. They did nothing to eliminate the horrible sensation that his phantom foot and leg were “getting electrocuted.”

So when Tsao approached him with his $20 mirror, “I felt like I might as well give it a try,” Paupore said. “I had nothing to lose.”

Mirror therapy complete, Paupore is now almost pain-free, and off his pain medication.

“I think the last time I had [a phantom-pain episode] was a month ago,” he said.

“Your mind is either your best friend, or your worst enemy,” Paupore said. “The mirror helps you rewire the thought process, so your mind can be your best friend again.”