a 30-year - old male patient received an above - elbow amputation about eight months prior to seeing us for an open fracture on the left radius and ulna due to trauma .
he ended up transferring from one department to another department since his condition did not improve at all during treatment due to constant and severe pain after the amputation surgery .
he kept complaining about cramping pain on his removed arm and electric - like pain occurring once every few minutes .
he also said that he felt the entire shape of his removed arm , and it was medially rotated .
every day , he was prescribed gabapentine ( 2,400 mg ) , oxycodon ( 200 mg ) , and amitriptyline ( 25 mg ) , with other medications to control the pain . however , the degree of his pain relief was somewhat insignificant and the visual analog scale ( vas ) was 8 - 10 out of 10 .
other treatment methods , such as stellate ganglion block , thoracic sympathetic ganglion block , brachial plexus block , cervical transforaminal epidural block , and a subcutaneous infusion of ketamine , were also done .
lastly , spinal cord stimulation ( scs ) was done for the patient , but the treatment effect was very insignificant . finally , we performed mirror therapy for the patient .
he had to visit the hospital four times a week and went through a 15-minute treatment period .
we had the patient feel the movement of his removed arm and hand just like his normal arm and hand moving through a mirror ( fig .
after a week passed , the patient said that he could feel his medially rotated arm was back to normal , and his vas level decreased to 7 out of 10 .
one month later , he said that the previous cramping pain was almost gone and the phantom hand and arm returned to normal . at that time , his vas level was 5 out of 10 .
after , three month from the initial therapy , he is doing a mirror therapy three to four times a week at home
. however , the electric like pain remains and the vas usually is maintained at 4 out of 10 .
he is under follow - up at our outpatient department with oxycodon decreased to 100 mg a day .
no treatment for phantom limb pain has yet been clearly proven in terms of its effect .
drug therapy includes narcotic drugs , anti - epileptic medications , topical anesthesia , and analgesics .
an infusion of ketamine , a n - methyl - d - aspartic acid receptor antagonist , was also introduced for phantom limb pain treatment .
meanwhile , non - drug therapy includes sympathetic ganglion block , transforaminal epidural block , peripheral nerve block , transcutaneous electrical nerve stimulation ( tens ) , direct cortical or spinal cord stimulation , and mirror therapy , etc .
mirror therapy was unveiled by ramachandran and rogers - ramachandran in 1996 . under this therapy
, a patient is allowed to feel the imaginary movement of the removed body part behaving as normal body movement through a mirror .
the mirror image of the normal body part helps reorganize and integrate the mismatch between proprioception and visual feedback of the removed body .
rizzolatti used a mirror neuron to explain the fundamentals of a mirror therapy . at first , a mirror neuron was found in the monkey premotor cortex , and later , rossi discovered that humans also have similar mirror neurons systems .
a mirror neuron fires both when a person acts and when a person observes the same action performed by another .
then , the neuron mirrors the behavior of the other , as though the observer were itself acting .
a mirror neuron provides observers with internally recognized experiences , making them understand other 's behaviors , intentions , and emotional status .
therefore , while mimicking the behavior of the other , observers can experience not only the sensation , but also the similar emotion of the other . in this sense
, a patient with phantom limb pain can feel the same sense or emotion of his / her normal body part by observing the mirror image . by doing so
, it is expected to decrease pain by resolving conflict between motor intention , proprioception and visual system .
a person without phantom limb pain and no amputations can not feel these sensory experiences since the signs from a non - mirror neuron block the mirror neuron , while a patient with an amputation does not have this non - mirror neuron system operating .
the visual observation can help feeling empathy , which explains how the mirror therapy works for a patient .
it is reported that the therapy is more effective on deep somatic pain ( e.g. , pressure sense and proprioceptive pain ) than on superficial pain ( e.g. , warmth sense and nociceptive pain ) .
this is because deep tissues are responsible for integrating sensorimotor nerves as well as creating movements compared to superficial tissues .
recently , mirror therapy has used for not only patients with phantom limb pain , but also for patients with complex regional pain syndrome and strokes .
many studies indicate that mirror therapy is only effective for upper limb treatment , but it has potential as alternative treatment for pain that is difficult to control . in this study ,
mirror therapy resulted in dramatic pain relief for a patient with chronic phantom limb pain when other treatments such as medications , physical therapies , nerve blocks , nerve transformations did not work .
mirror therapy is expected to be widely used for the treatment of phantom limb pain since it is easy to use at both home and in outpatient departments .
 phantom limb pain is a painful sensation that is perceived in a body part that no longer exists . to control this pain , 
 many methods have been used such as medication , physical treatment , nerve block , neuromodulation , surgical treatment and mirror therapy . however , until now , there effects have been uncertain . 
 we report the successful reduction of phantom limb pain using mirror therapy when other treatments initially failed to control the pain . 