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OHSU mirror therapy expert to provide free training in Vietnam

Pain specialist wins grant to teach therapy for amputees in nation with high prevalence of people who've lost limbs

Oregon Health & Science University's Beth Darnall, Ph.D., is an international expert on a novel therapy for "phantom limb pain" — real pain suffered by people who have had an arm or leg amputated. Darnall has studied and treats people with "mirror therapy," which lessens or eliminates the pain by tricking the amputee's brain into believing there was no amputation.

Now, Darnall has won a grant to take her expertise on a humanitarian mission to Vietnam — to help some of the tens of thousands of children and others in Vietnam who have lost a limb because of land mines and unexploded bombs from the Vietnam War.

"Vietnam has the highest rate of amputation in the world — mostly because of land mines and unexploded bombs," Darnall said. "And the amputations are still happening — often to children — more than 30 years after the war ended.

"Being from the United States, it's particularly gratifying to go and provide free pain education to help mitigate some of the suffering from this."

Darnall's team will include two physicians from Can Tho Medical University in Vietnam and a leader of the nonprofit End the Pain Project, which is dedicated to helping people reduce phantom limb pain. They will present three free workshops about mirror therapy to health care providers and aid workers in three cities in Vietnam, from Nov. 26 through Dec. 3.

HealthSaaS, a Portland-based company, is providing technology services, including an Internet portal powered by its Connected Outcomes Framework technology that will allow Darnall to coach patients and physicians and track Vietnam project outcomes from the United States.

"This outreach project is an efficient way to start helping the 580,000 amputees in Vietnam at a very low cost, using cloud-based technology to bring expert pain care to remote areas of the country," said Frank Ille, chief executive officer of HealthSaaS. "This project perfectly exemplifies the core mission and philosophy of HealthSaaS and we are excited to be a part of this humanitarian effort."

Darnall and her team hope workshop participants can provide the mirror therapy training to adults and children with amputated limbs — who can then perform the mirror therapy on their own in their own homes.

"The beauty of mirror therapy is it's easy to learn and do, and it has almost no cost — only the cost of a simple mirror that is as long as the amputated limb," Darnall said. "And it often works much better than expensive drugs that can have side effects and cause other problems."

About 80 percent of people with amputated limbs report phantom limb pain; the amputation has in essence confused their brain into perceiving pain that can be severe and often becomes lifelong.

With mirror therapy, the participant positions a long mirror across the midline of his or her body so the amputation site is hidden behind the mirror and the mirror reflects the image of the intact arm or leg. The participant then makes gentle movements with his intact limb, while looking at what appears to be another intact limb in the mirror.

The process is a form of "virtual reality" which appears to "trick" the brain. The effectiveness of mirror therapy for phantom pain was first discovered in the mid-1990s and has been confirmed in several large clinical studies, including one published in the New England Journal of Medicine in 2007. Studies have shown the process causes actual restructuring of parts of the brain, restructuring that then lessens or eliminates the pain. Findings from the New England Journal of Medicine study showed that mirror therapy was effective in reducing phantom pain after four weeks of regular practice.

Darnall published a case study in 2009 after she treated a man whose leg was amputated after he was struck by a car in 2006. Drugs had not helped his phantom limb pain, but after he practiced mirror therapy for 20 minutes daily for a month, he reported the pain had ended.

A more recent Darnall study involving 40 amputees has been accepted for publication in a rehabilitative medicine journal. Study results show that half of the participants who performed mirror therapy at home reported phantom pain reduction, with an average pain reduction of about 40 percent. Two participants reported 100 percent phantom pain resolution.

Darnall's team won the $10,000 grant for the Vietnam workshops from the International Association for the Study of Pain.

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