Consider the curious but tragic pain disorder called complex regional pain syndrome (CRPS). If you suffer a fracture after your finger is jammed in a doorway, pain ensues. Chronic pain results in a reflex immobilization of the hand to prevent further injury and promote healing. In a few days or weeks the tissue swelling and inflammation subside, along with the pain. But in a small percentage of cases, the immobilization turns into permanent paralysis, and the hand becomes progressively more swollen, painful, inflamed and dysfunctional. The pain and paralysis spread upward to involve the entire arm. There is no known treatment.

In a lecture we gave in 1996 at the University of California, San Diego, Decade of the Brain Symposium, we referred to this phenomenon as learned pain. Every time the motor command centers sent a command to move the hand, excruciating pain accompanying the command blocked further movement. In a few unlucky individuals, an unconscious association—or memory link—is established between the initial command itself and pain, so the brain just gives up: learned pain. Speaking metaphorically, the hand becomes immobilized by fear; it is paralyzed. Admittedly, a hand-wave argument, but nonetheless it is about as compelling an example of mind-body interactions that you can find in all of clinical medicine.

More than 20 treatments, many of them involving drugs or surgery, have been tried for CRPS. What they all have in common is they do not work. (One technique, sympathetic ganglion block, works to some extent but involves an invasive procedure.)

Can the pain be “unlearned”? Prompted by our successful pain-relief treatment using mirrors for patients with phantom limbs, Candy McCabe, now at the University of the West of England, Bristol, and her colleagues tried mirror therapy. The patient looks at the reflection and moves both hands symmetrically so that it appears to the brain that the affected arm—the left, for example—is moving but not painful after all. Similarly, stroking or hitting the right hand creates the optical illusion that the dystrophic hand is being stroked and hit with impunity. Perhaps these two bits of evidence remove the “block” on the affected arm leading to a positive cycle of pain reduction, accompanied by a reduction of swelling and redness.

Taken collectively, these were the first demonstrations that “real” chronic pain can be reduced by visual input; indeed, even intense visual imagery may turn out to be partially effective, but this is hard to do. We first tried mirror therapy on patients with phantom pain from amputated limbs. Sometimes the missing hand feels “locked” in a painfully awkward cramp that can be excruciating, and the patient cannot volitionally move the phantom. When he looks at the reflection, a series of things may happen. First, he “sees” his phantom and recognizes that it is not being poked or held in a vice after all; there is no reason for it to be painful. Second, merely seeing the phantom may be beneficial because the brain can attribute the pain to the arm and, paradoxically, a pain whose source is known may be less troubling than “disembodied,” inexplicable pain (caused by discordant visual and proprioceptive signals). Third, seeing the cramped, paralyzed hand move seems to animate it in such a way as to relieve the cramp, an example of successful clinical application of visual capture. Repeated use may lead to an unlearning of learned paralysis. In placebo-controlled clinical trials on returning war veterans, mirror visualization feedback has since been found to be strikingly successful in some patients and moderately so in others. (Jack Tsao and his colleagues at Walter Reed Army Medical Center conducted the trials.)

Remarkably, in controlled clinical trials, we and others have found mirror therapy to relieve paralysis from cerebrovascular stroke. This relief may be partly because the paralysis could be learned and partly because many paralyzed limbs also have a form of CRPS associated with them. Both these effects contribute to the limb paralysis, which would explain the relief provided by the mirrors.

3 Comments

1. 1. Spin-oza 12:15 PM 8/18/11

   Yes... the simple mirror can reveal a lot about how the physical brain has evolved, functions and fully instantiates the "mind" and thus the "soul".

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2. 2. ldgregg 01:22 AM 8/19/11

   When we were Catholic school girls in the 60's our nuns told us to never look in a mirror. It was "vane". Vanity was a bad thing back then. So, we grew up having no vision of ourselves (we were nothing). The problem was that the Church encouraged us to become well-educated and when we did, we found that - among many other things - this whole "mirror" thing was really wrong. Look in the mirror and REALLY look. Then, look into your heart and be thankful for who you are and your impression of yourself.
   
   

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3. 3. Seishindo 05:10 AM 8/26/11

   I am a big fan of this work and have been using a mirror box for some time now.
   In the article it is written;
   
   Using two bricks, or some duct tape, prop up an 18-inch-square mirror vertically on a table. Sit so that the edge faces you. Now put your left hand on the table at the left side of the mirror (either palm up or down) and match your right-hand position on the right side. If you now look into the right side of the mirror, you will see the right hand’s reflection optically superimposed in the same place where you feel your left hand to be.
   ///
   I am not sure what is being described.
   Are you setting the mirror so that it is close to perpendicular to you?
   Are you starting with it sitting close to one side of you?
   
   Is there a picture anywhere that I can use for reference?
   
   I will be very thankful for any help anyone can give.

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