Mirror box therapy & CBT for CRPS type 1, three case studies

In 2007 Tichelaar et al published a paper describing three case studies where mirror box therapy was combined with CBT. They measured pain (VAS), range of motion, muscle strength and regions that were allodynic (pain in response to a stimulus that is not normally painful) and hyperalgesic (increased response to painful stimuli) before, during and after the interventions. The authors found that indeed there were some positive changes, for example reduced pain at rest and increased range of motion.

Of course from three case studies we cannot draw strong conclusions but it seems sensible in certain cases to use the combined approach. Indeed the Stanton-Hicks model recommends physical therapy, psychology and medicine as an integrated model of care for CRPS. Pain is understood in a modern sense to be a multisystem output from the body requiring a biopsychosocial approach that considers the biology of the condition, the psychological influences and the social consequences. Thinking of pain in this way is beneficial in terms of being able to understand the presentation, explai the symptom profile, select appropriate treatment techniques and draw upon the skill mix of physiotherapy, psychology and medicine as required.

Mirror box therapy added to cognitive behavioural therapy in three chronic complex regional pain syndrome type 1 patients: a pilot study. Tichelaar et al. (2007) Int J Rehabil Res 30:181-188