Phantom Limb Clinical Trial
Official title:
Psychosocial and Visual Feedback Intervention for Phantom Limb Pain
The goal of this study is to test whether a combination of cognitive-behavior therapy and mirror training reduces phantom limb pain for veterans with amputations.
The proposed study is a randomized controlled trial designed to test whether CBT plus mirror
therapy (CBT+MT) is superior to supportive care (SC) for treatment of phantom limb pain (PLP)
in amputees. The primary hypothesis is that CBT+ MT will lead to significantly greater
reductions in PLP compared to SC. Secondary hypotheses will test whether CBT+MT also leads to
significantly greater improvements in psychiatric symptoms, functioning, and quality of life
than SC.
Eighty veterans from the San Diego VA Healthcare System (SDVAHS) will be recruited. All
veterans will have a unilateral upper or lower limb amputation. All participants will
complete an intake assessment prior to treatment randomization. The assessment will include
measures of pain (Phantom Limb Pain Questionnaire, Descriptive Differential Scale, McGill
Pain Questionnaire) psychiatric symptoms (Patient Health Questionnaire, Posttraumatic Stress
disorder Checklist), psychiatric diagnosis (Mini-International Neuropsychiatric Interview)
and functioning (Trinity Amputation and Prosthesis Experiences Scale, Short Form-36).
Participants will then randomized to either CBT+MT or SC. Participants will complete pain and
mood assessments weekly during treatment, and be retested on the full assessment battery at
the end of treatment and 12 and 24 weeks posttreatment.
The CBT+MT intervention will consist of 8 individual sessions of CBT, including
psychoeducation, cognitive restructuring, relaxation training, and acceptance techniques.
Participants in the CBT+MT condition will also learn to use a mirror apparatus to reduce PLP,
and will receive a set of mirrors to use at home. The SC treatment will consist of the
therapist meeting with the patient and using listening and reflection skills to discuss the
patient's pain. The SC condition will have no pain education or skills training component.
Data analyses will use a repeated-measures ANOVA approach to test whether the two conditions
differ on change in the primary measure (Phantom Limb Pain Questionnaire) as well as in other
pain, psychiatric symptom, functioning and quality of life measures. Exploratory analyses
will test whether patient variables and amputation characteristics predict treatment
outcomes.
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