A novel mixed reality system to manage phantom pain in-home: results of a pilot clinical trial.

Introduction: Mirror therapy for phantom limb pain (PLP) is a well-accepted treatment method that allows participants to use a mirror to visually perceive the missing limb. Mixed reality options are now becoming increasingly available, but an in-home virtual mirror therapy option has yet to be adequately investigated. Methods: We had previously developed a mixed reality system for Managing Phantom Pain (Mr. MAPP) that registers the intact limb and mirrors it onto the amputated limb with the system's visual field, allowing the user to engage with interactive games targeting different large lower limb movements. Feasibility and pilot outcomes of treating patients with lower extremity PLP by using Mr. MAPP at home for 1 month were evaluated in this study. Pain intensity and interference were assessed using the McGill Pain Questionnaire, Brief Pain Inventory, and a daily exercise diary. Function was assessed using the Patient Specific Functional Scale (PSFS). The clinical trial registry number for this study is NCT04529083. Results: This pilot study showed that it was feasible for patients with PLP to use Mr. MAPP at home. Among pilot clinical outcomes, statistically significant differences were noted in mean current pain intensity [1.75 (SD = 0.46) to 1.125 (SD = 0.35) out of 5, P = .011] and PSFS goal scores [4.28 (SD = 2.27) to 6.22 (SD = 2.58) out of 10, P = .006], with other outcome measures showing non-significant trends towards improvement. Discussion: This pilot study revealed that in-home use of Mr. MAPP has potential to provide pain relief and improve function in patients with lower extremity PLP and is feasible. Each scale used provided unique perspective on the functional impact of PLP. Further expanded studies and investigation, including a fully powered clinical trial, with these scales are warranted. Clinical Trial Registration: https://www.clinicaltrials.gov/ct2/show/NCT04529083, Identifier: NCT04529083.

Clinical feasibility and preliminary outcomes of a novel mixed reality system to manage phantom pain: a pilot study.

BACKGROUND: To assess the clinical feasibility of a virtual mirror therapy system in a pilot sample of patients with phantom pain. METHODS: Our Mixed reality system for Managing Phantom Pain (Mr. MAPP) mirrors the preserved limb to visualize the amputated limb virtually and perform exercises. Seven patients with limb loss and phantom pain agreed to participate and received the system for 1-month home use. Outcome measures were collected at baseline and 1 month. RESULTS: Four (of seven recruited) participants completed the study, which was temporarily suspended due to COVID-19 restrictions. At 1 month, in-game data showed a positive trend, but pain scores showed no clear trends. Functioning scores improved for 1 participant. CONCLUSIONS: Mr. MAPP is feasible and has the potential to improve pain and function in patients with phantom pain. TRIAL REGISTRATION: Clinical Trials Registration, NCT04529083.

Heterotrophic Ossification in Patient With Prosthetic Leg.

Heterotrophic ossification (HO) is a well-described phenomenon in patients with spinal cord injury, head injury, burns, hip replacement, and general trauma. However, it has also been described through a relative paucity of case reports that repeated microtrauma from the use of weight-bearing leg prostheses is an additional possible cause of HO. In our case, we examine a patient who developed an extreme case of HO after he began an exercise regimen with assistance from a running limb. This abnormal formation was actually advantageous because it created a more snug fit of the prosthetic device and improved the patient's ability to run.

Diagnostic Evaluation of Chronic Pelvic Pain.

Chronic pelvic pain can result from various intra- and extra-pelvic etiologies. Although patient history and physical examination may narrow the differential diagnosis, frequently, the different etiologies have overlapping presentations. Imaging examinations such as US and/or MR imaging may help delineate the cause of pain, particularly when related to intra-pelvic organs, pelvic floor dysfunction or prolapse, synthetic material such as pelvic mesh or slings, and in some cases of neuropathic pain. Etiologies of neuropathic pain can also be assessed with non-imaging tests such as nerve conduction studies, electromyography, and testing of sacral reflexes.