Means of reflection: mirrors help treat SWO veterans for phantom pains

Russian doctors are introducing a new method of getting rid of phantom pains that occur during amputation of limbs. The first patients to receive the therapy were veterans of combat operations. More than 100 people have already undergone treatment using a special system of mirrors called "FaBo Mirror". Medics have achieved pain relief in 70% of patients. The new approach is based on the principle of neuroplasticity - the ability of the brain to change under the influence of experience. According to military doctors, phantom sensations are a serious problem for veterans of the Army. And new effective solutions are needed for it. However, experts note that the proposed approach may have complications, so it needs to be thoroughly tested.

Impact on the brain with the help of a mirror

Specialists of the Pirogov Russian National Research Medical University are putting into practice a new technique to combat phantom pain in patients who have lost limbs. The technique using a system of mirrors, called "FaBo Mirror", is now used primarily for the rehabilitation of combatants. It helps restore mental function. The work is being carried out in several medical institutions, in particular, in War Veterans Hospital No. 3. More than 100 people have already undergone treatment, and more than 70% of them have seen a noticeable improvement.

- Overcoming pain syndrome after the loss of upper or lower limbs is the main condition for comprehensive rehabilitation. Such pains do not allow a person to focus on anything. They occur involuntarily, and even when the patient does not experience them, he waits for them and remains in tension. The painful condition can last from a few minutes to several hours, and it is very exhausting. Both physically and emotionally," said Vera Nikishina, head of the Department of Clinical Psychology at Pirogov University.

Feelings of phantom pain cause neural traces, which are "amplified" if the attacks continue for a long time and often repeated. To combat them with the help of mirror therapy uses the principle of neuroplasticity, that is, the ability of the brain to change under the influence of experience. In the course of therapy there is a weakening of old pain "traces" and the formation of new neural circuits that are not associated with the sensation of pain, explained the specialist.

Work with the patient begins with a clinical conversation, during which the doctor finds out the nature, intensity and frequency of pain attacks. Special questionnaires and diagnostic scales are used to more accurately convey subjective sensations. Then, using a system of mirrors, the image of a healthy limb is projected in place of the missing limb so that the patient sees a realistic image of himself with both arms or legs. This affects the way the brain works.

Photo: press service of Pirogov University

The exercises begin with sensory recognition tasks, where the patient uses the healthy limb to identify, for example, a prickly, soft or warm object. This is done in a strictly defined order. The patient is then asked to perform a set of so-called neurotests - detailed actions that follow the doctor's instructions.

- All exercises consist of neurodynamic tests. For example, the doctor instructs: place your hand with your fist on the table, then turn it on its edge, and then place it on the table with its entire surface. This is called a dynamic praxis test (reproduction of the motor program according to the pattern. - Ed.) "fist-rib-palm". Then the doctor quickly repeats the commands, and the patient fulfills them, - said Vera Nikishina.

The next stage involves activation of the patient's tactile sensitivity. This is realized through object interaction with the specialist, which engages the somatosensory and associative cortex of the patient's brain. For example, the patient with closed eyes is offered to identify by touch and name various wooden letters hidden in a bag.

Comprehensive rehabilitation after injury

All exercises are performed in a strictly defined sequence. In the course of these actions, the patient sees how the mirror "limb" acts, which is perceived by the brain as a real one. 15-20% of patients who have used the method, only one session is enough to alleviate pain, said the doctor. So far, doctors can not say exactly how long the achieved effect lasts, as the work on the new method began not so long ago. However, practice shows that the anesthesia is definitely preserved for several days.

For the military, wounded in the course of SWO, overcoming phantom pains is the most important task. And the method proposed by the specialists of Pirogov University should be in demand, told "Izvestia" veteran of the medical service of the Navy Nikolai Alekseev.

- There are a lot of such patients now. They need our help and support. If it will have a positive impact, including on their psychological state, the method will be very useful for them in further rehabilitation and recovery, - Nikolai Alekseev is sure.

The mechanism of the mirror therapy method for phantom pain in amputated limbs is directly opposite to the mechanism of restoration of motor skills in patients after stroke due to activation of motor areas of the brain, said Olga Valaeva, head of the Virtual Clinic at the Moscow Institute of Psychoanalysis.

Photo: press service of Pirogov University

- While extensive experience has been accumulated in neuropsychological rehabilitation after strokes and the phenomenon underlying it, in which neuroplasticity allows other parts of the brain to compensate for lost functions, the mirror therapy method has yet to undergo numerous studies, the method requires additional observations, - said Olga Valaeva.

In some ways, the risks of using the mirror method may be similar to the risks of using augmented reality. Motion illusions can provoke various cognitive disorders, destructive states, depersonalization, the specialist stressed.