Rheumatology Advance Access originally published online on May 7, 2008
Rheumatology 2008 47(7):1038-1043; doi:10.1093/rheumatology/ken170
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Mirror visual feedback alleviates deafferentation pain, depending on qualitative aspects of the pain: a preliminary report
1Department of Acute Critical Medicine (Anesthesiology), Osaka University, Graduate School of Medicine, 2Center for Pain Management, Osaka University Medical Hospital, Osaka, 3Kobe Advanced ICT Research Center, National Institute of Information and Communications Technology, Kobe, Japan, 4The Royal National Hospital for Rheumatic Disease (RNHRD), The School for Health, University of Bath, Bath, UK, 5Department of Neurosurgery, Osaka University, Graduate School of Medicine, Osaka and 6Integration of Human Expression and Behavior, Kyoto Women's University, Graduate School of Arts and Education, Kyoto, Japan.
Correspondence to: M. Sumitani, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan. E-mail: masasumi{at}anes.med.osaka-u.ac.jp
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Abstract |
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Objectives. Following lesions in somatosensory pathways, deafferentation pain often occurs. Patients report that the pain is qualitatively complex, and its treatment can be difficult. Mirror visual feedback (MVF) treatment can improve deafferentation pain. We sought to classify the qualities of the pain in order to examine whether the potential analgesic effect of MVF depends on these qualities.
Methods. Twenty-two patients with phantom limb pain, or pain related to spinal cord or nerve injury, performed a single MVF procedure. Before and after the MVF procedure, we evaluated phantom limb awareness, movement representation of the phantom or affected/paralysed limb, pain intensity on an 11-point numerical rating scale (0–10) and the qualities of the pain [skin surface-mediated (superficial pain) vs deep tissue-mediated (deep pain)] using lists of pain descriptors for each of the two categories.
Results. Fifteen of the patients perceived the willed visuomotor imagery of the phantom or affected/paralysed limb after the MVF procedure. In most of the patients, a reduction in pain intensity and a decrease in the reporting of deep-pain descriptors were linked to the emergence of willed visuomotor imagery.
Conclusions. In this pilot study, we roughly classified the pain descriptor items into two types for evaluating the qualities of deafferentation pain. We found that visually induced motor imagery by MVF was more effective for reducing deep pain than superficial pain. This suggests that the analgesic effect of MVF treatment does depend on the qualities of the pain. Further research will be required to confirm that this effect is a specific consequence of MVF.
KEY WORDS: Deafferentation pain, Phantom limb pain, Mirror visual feedback, Neurorehabilitation, Visuomotor imagery, Pain description, Pain category, Superficial-mediated pain, Deep tissue-mediated pain, Origin of pathologic pain
Submitted 7 September 2007;
revised version accepted 2 April 2008.
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