Relaxation & Guided Imagery Reduce Phantom Limb Pain

Researchers from the Santa Lucia Foundation IRCCS and Tor Vergata University in Rome, Italy, evaluated the impact of progressive muscle relaxation, guided imagery and phantom exercises on phantom pain in 51 subjects with unilateral lower limb amputation who experienced phantom limb pain (PLP) and/or phantom limb sensation (PLS).

The randomized controlled prospective trial was conducted on the amputee unit of a rehabilitation hospital, using 2 parallel groups.

The experimental group received combined training of progressive muscle relaxation and mental imagery, and phantom exercises 2 times/wk for 4 weeks, while the control group had the same amount of physical therapy dedicated to the residual limb. No pharmacological intervention was initiated during the trial period.

The Prosthesis Evaluation Questionnaire and the Brief Pain Inventory were used to evaluate changes over time in different aspects (intensity, rate, duration, and bother) of PLS and PLP. Blind evaluations were performed before and after treatment and after 1-month follow-up.

The experimental group showed a significant decrease over time in all the Prosthesis Evaluation Questionnaire domains (in terms of both PLS and PLP; P<.04 for both) and the Brief Pain Inventory (P<.03). No statistically significant changes were observed in the control group. Between-group analyses showed a significant reduction in intensity (average and worst pain) and bother of PLP and rate and bother of PLS at follow-up evaluation, 1 month after the end of the treatment.

The investigators conclude that combined training of progressive muscle relaxation, guided imagery, and modified phantom exercises are a valuable technique to reduce phantom limb pain and sensation.

Citation: Brunelli S1, Morone G2, Iosa M2, Ciotti C3, De Giorgi R2, Foti C3, Traballesi M2. Efficacy of progressive muscle relaxation, mental imagery, and phantom exercise training on phantom limb: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation. 2015 Feb; 96 (2): pages 181-7. doi: 10.1016/j.apmr.2014.09.035. Epub 2014 Oct 23.