Wednesday, July 28, 2010

Mirror, Mirror

I was talking with a friend of mine at the pool today. She was formerly a regular in our time slot at this pool, a session mainly attended by disabled people and octogenarians.

It had been a while since I saw her there. I can never tell if a person's long absence is a good sign or a bad one-- either they are doing well and don't need pool therapy or they're having a hard time and just can't make it.

Turns out my friend falls into the not-so-good category.

A few years ago her shoulder was badly injured in a motorcycle crash and ever since she has experienced severe neuropathic pain in her arm. She says that the slightest touch can make it feel like her arm is held over a fire, buried in ice or ... In short, the most excruciating agony you can imagine.

The currently available treatments for this condition, unfortunately, are notoriously unreliable and must be tailored to each individual patient. Basically you keep trying things until something works.

For my friend this has meant a constantly changing combination of medications which have very different primary uses, from antidepressants and anticonvulsants to topical analgesics, cannabinoids and botox. These have many side effects and she has had to suffer through them all.

I guess I haven't seen her in about 10 weeks or so. In that time, she told me today, she has gained and lost 40 pounds ( she's about 5'-5"). Sudden weight gain was a side effect of one medication and then she switched to another which made her nauseous for two months.

There is a light at the end of the tunnel, though. She is very excited to be starting a program at a local university hospital's pain center. The therapy she's holding out hope for is called Mirror Box treatment.

I had heard of this before and knew it was used experimentally in so-called "split brain" patients but I didn't know it was being used successfully in treating "Phantom Limb Pain" in amputees and helping stroke patients.

One hand is placed inside a box where you can't see it and the other is reflected in the mirror on the outside of the box. From your point of view, you're looking at your right hand, say, and the illusion of your left. Exercises are then performed which have the effect of syncing up your left and right sides. The idea is to change your perception of your own body and somehow retrain your brain to use neural pathways differently.

How does this relieve pain? You got me. But if it works, it is surely better than taking a bunch of pills and waiting to see what happens. Stay tuned.


knitica said...

I've been hearing about this as therapy for phantom limb pain for a few years now. In that situation it even allows you to massage the remaining limb while watching the reflected phantom limb receive the same treatment. The human brain is a fascinating thing.

Stefaneener said...

Absolutely fascinating. I think we're going to find more and more ways that the brain can help heal bodies than we could even imagine now. You're obviously a good friend to this person.

Meredith said...

Oh, I so hope this heals or at least alleviates your friend's pain. And I am definitely going to be telling a good friend of mine about this. She's a poet and was electrocuted (!) at work when waitressing in grad school (long story) and has never been able to write by hand since, a terrible loss for a poet, but struggles with constant pain in her dominant hand and arm -- and nothing yet discovered that really seems to help.

Thanks for sharing this Lisa. I hope we're on the front edge of a wave of new understanding of the brain and its miraculous potential.

Martha said...

I have a really really dumb question. Which hand goes in the box? The good one or the bad one?

Robb said...

Good question. A quote from the Neurotopian blog:

"Say you have one affected limb ...
You put a mirror in front of you - put the affected limb behind the mirror so that it is hidden from view - the other one goes on front - and you start moving both in the same fashion ...of course know that the limb that you see in the mirror is just a reflection of the healthy one - but your brain can't.

Vision is a very useful but notoriously unreliable sense. Just look at any visual illusion to see how easy it is to fool the eyes/brain.
the illusion of movement.

The brain thinks that the limb in the mirror is perfectly alright ...

Sensory-motor congruence is re-established and the brain stops sending warning messages to higher centers of the brain - what we call "pain".

Somatosensory maps are re-modeled (which happens very quickly) - and the pain is gone (forever).

This is one the key points of this type of treatment: it actually changes the very structure of your brain! "

Anonymous said...

Fascinating! I have never ever heard of mirror therapy. I hope it works. Remember, the human brain is the largest muscle in the body, right? That's got to count for something...



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