Mirror, mirror on the wall
Can you help my pain, after all?

Well, that’ a version of the rhyme that never made it into Snow White! But if you’re looking for pain relief (instead of finding out who’s the fairest of them all :), mirror boxes might offer an answer. Mirror image therapy is an exciting treatment for many pain syndromes. Today we’ll look at Complex Regional Pain Syndrome (CRPS), also called RSD. CRPS is a neurological pain disorder with symptoms which include:

• pain out of proportion to any injury
• movement problems, e.g. muscle spasm, clumsiness
• temperature control problems, e.g. the affected area becomes cold or hot out of the blue, excessive sweating, pain increases with exposure to cold

There’s a lot that’s unknown about CRPS, but we do know that the changes that occur in CRPS affect not only the area where there’s pain, commonly a hand, foot, arm or leg. The changes also involve the spinal cord and brain. The body map hypothesis may apply to CRPS. This hypothesis says that there’s an internal representation of your body in your brain. This picture helps you know where your body is in space, even with your eyes shut. It also helps you perform movements, without having to think about each little part of a complex movement.

In CRPS, the brain’s map of the area where there’s pain may become distorted. It’s not clear if this distortion is a cause or a result of pain, but correcting this distortion can help. In CRPS, movement often hurts and can make pain worse. But lack of movement means fewer normal sensations coming into the brain. This allows pain signals to get too much play in your brain, creating a sort of spiraling feedback loop…

pain, which causes you to move less, which causes fewer normal movement sensations going to your brain, which causes pain signals have less to compete with to get your brain’s attention, which causes PAIN, and we’re back to the beginning

So where do mirror boxes come in? Let’s say your right hand is affected by CRPS. You can put your right hand in the box so it’s not visible. You then move your left hand, and your brain sees the reflection as if your right hand is moving. And because your left unaffected hand is moving, the movements are easy and fluid. So it looks to your brain like you’re right hand’s moving comfortably and easily. It may be that tricking your brain into seeing that everything’s ok, lets pain begin to slowly decrease.

Now for the “be careful” section…

1. It gets trickier to use a mirror if…
   – both your right and left side are affected, i.e. there’s no pain-free part
   – an area like your chest, back, or stomach is affected, where there’s not an obvious mirror image part
2. It’s controversial if you can just start out using a mirror, or you need to build up to this kind of work, by graded motor therapy.
3. It’s also controversial if you need to move the hand or foot that’s in the mirror box, i.e. the affected limb that’s hidden from view.

So, if you’re interested in mirror therapy, take a look at the NOI website. Read some more on the treatment to educate yourself. And, most importantly, get some guidance from a medical practitioner – MD, physical therapist, etc. – who’s informed about this treatment. It’s a very exciting option – and one I want to make sure you use safely. You can learn more as well as purchase a mirror with instructions for use:

NOI Group