Deutsche medizinische Wochenschrift
-
Dtsch. Med. Wochenschr. · Oct 2007
Review[Mirror feed-back - a new method for the treatment of neuropathic pain].
The mirror feedback therapy is a method for treatment of neuropathic pain syndromes that are associated with a missing or disordered afferent sensory input. That concerns especially the phantom limb pain, the pain after plexus or spinal nerve root injury and the complex regional pain syndrome. This therapeutic method has been increasingly implemented in the past few years. ⋯ During the therapy the patients are instructed to use the mirror in a way that the image of the mirrored healthy limb seems to appear in the place of the missing or affected extremity. The mirror image produces an illusion of two "healthy" limbs. An ergotherapeutic training program with sensory and motor training elements based on the visual impressions is performed additionally.
-
Pain usually is the consequence of tissue damage that is signalled to the brain via the nociceptive system (nociceptive pain). Damage to the nociceptive system - in addition to causing sensory deficit - may paradoxically also induce a chronic pain state (neuropathic pain). Diagnostic workup of patients with neuropathic pain follows the usual procedure of Neurology, i. e. the aim is to identify the location of neural damage and the underlying disorder, so that a mechanism-oriented treatment may be initiated. ⋯ Typical analgesics have little efficacy in neuropathic pain - except for opioids. Major pharmacological treatment options include anticonvulsants (Ca-channel modulators, Na-channel blockers), antidepressants (noradrenaline reuptake inhibitors) and topicals (lidocaine, capsaicin). These medications exert specific molecular pharmacological effects against the pathophysiological mechanisms of neuropathic pain.