Background: At least 50% of people who undergo amputations suffer from phantom-limb pain (PLP). Central changes in numerous brain regions including somatosensory and motor areas appear to be a major determinant of PLP. Both peripheral and psychological factors seem to contribute to the alterations. One main reason for surgical amputations in poor countries who have experienced war is the presence of numerous landmines left behind. Landmine victims in low-income remote communities experience PLP and stump pain, with poverty and emotional stress also being contributing factors. In underprivileged communities where the burden of trauma is high, feasible treatment options are needed. Aims: The aim of the study was to examine the effect of mirror and tactile therapy on phantom and stump pain in patients with traumatic amputations, with particular reference to amputees in low-income communities. Methods: The study was conducted with an open, randomized, semi-crossover case-control design in rural Cambodia A study sample of 45 landmine victims with trans-tibial amputations was allocated to three treatment arms; mirror therapy, tactile therapy, and combined mirror and tactile therapy. Non-responders from the mono-therapy interventions were crossed over to the alternative intervention. The intervention consisted of 5 min (10 min for the combined arm) treatment every morning and evening for 4 weeks. PLP and stump pain were outcome variables measured with visual analogue scale (VAS). Endpoint estimates of PLP and stump pain were registered 3 months after the treatment. Results: All three interventions were associated with more than 50% reduction in VAS rated PLP and stump pain. Combined mirror-tactile treatment had a significantly better effect on PLP and stump pain than mirror or tactile therapy alone. The difference between the three treatment arms were however slight, and hardly of clinical relevance. After treatment, the reduction of pain remained unchanged for an observation period of 3 months. Conclusions: Four weeks practice of mirror therapy and tactile treatment causes a sustained reduction of PLP and stump pain in the majority of trans-tibial amputees. The most efficient method seems to be simultaneous mirror therapy and tactile treatment, or the two interventions serially. The interventions are simple and cheap, thus appropriate to the treatment of PLP in low-resource communities. Implications: The article reports for the first time a randomized controlled trial of mirror therapy and tactile treatment in a homogenous sample of persons with traumatic unilateral trans-tibial amputations after landmine trauma. The findings of this study are of special relevance to amputees in low-resource communities, where feasible and low cost treatment methods are needed.
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