title: Efficacy of progressive muscle relaxation, mental imagery, and phantom exercise training on phantom limb: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the reduction in phantom pain and sensation with combined training of progressive muscle relaxation, mental imagery, and phantom exercises.
  
  
  METHODS
  Randomized controlled prospective trial with 2 parallel groups.
  
  
  METHODS
  Amputee unit of a rehabilitation hospital.
  
  
  METHODS
  Subjects with unilateral lower limb amputation (N=51) with phantom limb pain (PLP) and/or phantom limb sensation (PLS).
  
  
  METHODS
  The experimental group performed combined training of progressive muscle relaxation, mental imagery, and phantom exercises 2 times/wk for 4 weeks, whereas the control group had the same amount of physical therapy dedicated to the residual limb. No pharmacological intervention was initiated during the trial period.
  
  
  METHODS
  The Prosthesis Evaluation Questionnaire and the Brief Pain Inventory were used to evaluate changes over time in different aspects (intensity, rate, duration, and bother) of PLS and PLP. Blind evaluations were performed before and after treatment and after 1-month follow-up.
  
  
  RESULTS
  The experimental group showed a significant decrease over time in all the Prosthesis Evaluation Questionnaire domains (in terms of both PLS and PLP; P<.04 for both) and the Brief Pain Inventory (P<.03). No statistically significant changes were observed in the control group. Between-group analyses showed a significant reduction in intensity (average and worst pain) and bother of PLP and rate and bother of PLS at follow-up evaluation, 1 month after the end of the treatment.
  
  
  CONCLUSIONS
  Combined training of progressive muscle relaxation, mental imagery, and modified phantom exercises should be taken into account as a valuable technique to reduce phantom limb pain and sensation.
authors.affiliation: Santa Lucia Foundation IRCCS, Scientific Institute for Research, Hospitalization and Health Care, Rome, Italy. Electronic address: s.brunelli@hsantalucia.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Brunelli
authors.affiliation: Santa Lucia Foundation IRCCS, Scientific Institute for Research, Hospitalization and Health Care, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Morone
authors.affiliation: Santa Lucia Foundation IRCCS, Scientific Institute for Research, Hospitalization and Health Care, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Iosa
authors.affiliation: Physical and Rehabilitation Medicine, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ciotti
authors.affiliation: Santa Lucia Foundation IRCCS, Scientific Institute for Research, Hospitalization and Health Care, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: De Giorgi
authors.affiliation: Physical and Rehabilitation Medicine, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Foti
authors.affiliation: Santa Lucia Foundation IRCCS, Scientific Institute for Research, Hospitalization and Health Care, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Traballesi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000379:methods; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009126:Muscle Relaxation; D010147:Pain Measurement; D010591:Phantom Limb / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies
keywords: Amputation; Chronic pain; Phantom limb; Rehabilitation; Sensation