5 Motor Imagery Solutions for Phantom Limb Pain & Reflex Sympathetic Dystrophy
A Natural Health and Wellness Essay.
Limbs in Space
Our brain keeps track of where our limbs are in space. When a limb is removed areas of the brain, particularly the right inferior parietal lobe adapt, sometimes in a way that causes pain.
“Event-related desynchronization of EEG in the beta band (beta-ERD) in central and parietal areas showed an angular disparity specifically in amputees with phantom limb perception, with its source localized in the right inferior parietal lobule. Our results suggest that phantom limb perception during the task is an important interferential factor for motor imagery after amputation and the interference might be related to a change of the body representation resulting from an unnatural posture of the phantom limb.”
— Lyu, Y., X. Guo, et al. (2016). “Phantom limb perception interferes with motor imagery after unilateral upper-limb amputation.” Sci Rep 6: 21100.
Motor imagery can be changed though and practiced. One way to practice with phantom limb pain or reflex sympathetic dystrophy (RSD), known now as Complex regional pain syndrome (CRPS) is to use a mirror behind which is the painful limb. Look into the mirror you will see the opposite limb. Move that healthy or pain-free limb as you watch it in the mirror. The brain will start to remodel and “see” the absent or painful limb moving and feels no pain and so start to think of the area as pain-free.
Intention to Move
Other research indicates that the intention to move affects both healthy hands and phantom hands.
“Voluntary actions are often accompanied by a conscious experience of intention. The content of this experience, and its neural basis, remain controversial. On one view, the mind just retrospectively ascribes intentions to explain the occurrence of actions that lack obvious triggering stimuli. Here, we use EEG frequency analysis of sensorimotor rhythms to investigate brain activity when a participant (CL, co-author of this paper) with congenital absence of the left hand and arm, prepared and made a voluntary action with the right or the phantom “left hand”. Our results suggest that conscious intention may depend on preparatory brain activity, and not on making, or ever having made, the corresponding physical body movement. In contrast, the results are consistent with the view that specific neural events prior to movement may generate conscious experiences of positive and negative volition.”
— Walsh, E., C. Long, et al. (2015). “Voluntary control of a phantom limb.” Neuropsychologia 75: 341–348.
If you have phantom limb pain or hand pain try this: Sit near a table on which is a cup. Close your eyes. Decide which hand you are going to reach out with to pick up the cup. Think about reaching out and what will happen when you reach out. Is there a difference when you intention to do this with your right hand or your left hand?
If the pain or missing limb is the foot or knee, do a similar task but intention to kick a ball.
Morning Meditation
Another kind of motor imagery that can help decrease pain is the following. As you wake up in the morning keep your eyes closed. “See” in your mind’s eye the movement of the absent or painful limb. For example, imagine the movement of your hand opening and closing. “See the movement in the most vivid detail possible. Notice how the finger nail moves. Notice the color of the skin. Is it uniform or are some parts shaded differently than other parts? Notice the sensation as one finger brushes up against another. Hear the sounds that the hand makes as it moves, rubbing, clapping, touching a drum. Here is what the research says about phantom movement.
“After limb amputation, patients often wake up with a vivid perception of the presence of the missing limb, called “phantom limb”. Phantom limbs have mostly been studied with respect to pain sensation. But patients can experience many other phantom sensations, including voluntary movements. The goal of the present study was to quantify phantom movement kinematics and relate these to intact limb kinematics and to the time elapsed since amputation. Results show that the execution of phantom movements is perceived as “natural” but effortful. The types of phantom movements that can be performed are variable between the patients but they could all perform thumb flexion/extension and global hand opening/closure. Finger extension movements appeared to be 24% faster than finger flexion movements. Neither the number of types of phantom movements that can be executed nor the kinematic characteristics were related to the elapsed time since amputation, highlighting the persistence of post-amputation neural adaptation. We hypothesize that the perceived slowness of phantom movements is related to altered proprioceptive feedback that cannot be recalibrated by lack of visual feedback during phantom movement execution.”
— De Graaf, J. B., N. Jarrasse, et al. (2016). “Phantom hand and wrist movements in upper limb amputees are slow but naturally controlled movements.” Neuroscience 312: 48–57.
Spinal Cord and Oxygen
Researchers noted, “The aim of the present article is to highlight the possibility of apply spinal cord stimulation for the simultaneous treatment of phantom limb pain and critical lower limb ischemia on the contralateral lower limb after failure of medical therapy in a group of 3 patients, obtaining pain relief in both lower limbs, delaying an endovascular or surgical revascularization. After spinal cord stimulation implantation and test stimulation, the pain was reduced by 50% on both the right and the left side in all our patients. The main indications for permanent spinal cord stimulation therapy after 1 week of test stimulation were represented by transcutaneous oxygen (TcPO2) increase >75%, decrease of opioids analgesics use of at least 50% and a pain maintained to within 20–30/100 mm on visual analog scale.”
— De Caridi, G., M. Massara, et al. (2016). “Spinal Cord Stimulation Therapy for the Treatment of Concomitant Phantom Limb Pain and Critical Limb Ischemia.” Ann Vasc Surg.
So what do you do if you don’t want spinal cord surgery? What are other ways to stimulate the spinal cord and increase oxygen to the tissues and decrease opioids? Acupuncture to the spinal region, chiropractic treatments, osteopathic manual therapy, exercise can all improve spinal function, tissue oxygen and decrease pain. One breathing exercise is as follows. Sit or stand erect as you take a breath in. Imagine that a crane is pulling to top of your head upwards elongating your spine. Do this as a visualization or really lengthen your spine as you breath in. As you breath out relax your spine and let the natural curvature of the spine come back into the back. Relax your hips and shoulders as you breathe out as well.
Another exercise for better tissue oxygenation is to rub, needle or in some way stimulate the Lung one point from acupressure. The Lu1 points are located near the front of each shoulder just in from the shoulder and below the collar bone.
Acupuncture / Acupressure
In a study to achieve consensus among a group of acupuncture practitioners on the pathology and recommended treatment of Phantom Limb Pain and devise an acupuncture protocol for the treatment of this condition researchers said,
“This protocol advises: Using a combination of body and auricular acupuncture; Treating the contralateral limb and possibly the ipsilateral limb; Including auricular acupuncture points such as shenmen, sympathetic and points corresponding to the lower limb; Depending on the health of the tissue and the individual participant, needling around the stump; Mirroring local and distal points by needling the opposite limb; Including points on the lower back (taking a segmental approach to dermatomal pain); Including points such as LI4 + LR3, LR3, GV20, SP10 and also specified points according to participants’ specific symptoms; Retaining needles for 20 to 30 minutes.”
— Trevelyan, E. G., W. A. Turner, et al. (2015). “Acupuncture for the treatment of phantom limb pain in lower limb amputees: study protocol for a randomized controlled feasibility trial.” Trials 16: 158.
Acupuncture points can be stimulated in many ways. Of course the most common way is with acupuncture needles, rubbing with acupressure. Other ways also work like tapping on the points with techniques like Emotional Freedom Technique, vibrating the points with sound or the clicker, or color, aromatherapy, physical functional medicine (PFM) rhythms.
Originally published at https://www.linkedin.com on February 19, 2016.
