• Roberto Casale, Carlo Damiani, and Venessa Rosati.
• Department of Clinical Neurophysiology and Pain Rehabilitation Unit (RC), Foundation Salvatore Maugeri IRCCS, Montescano, Italy.
• Am J Phys Med Rehabil. 2009 Oct 1; 88 (10): 837-42.

ObjectiveMirror box therapy and its development (immersive virtual reality) is used in pain therapy and in rehabilitation of people with amputation affected by phantom limb-related phenomena. It allows patients to view a reflection of their anatomical limb in the visual space occupied by their phantom limb. There are only limited reports of its possible side effects.DesignWe retrospectively reviewed the existence of side effects or adverse reactions in a group of 33 nonselected patients with phantom limb-related phenomena.ResultsNineteen reported confusion and dizziness, 6 reported a not clearly specified sensation of irritation, and 4 refused to continue the treatment. Only 4 of the 33 patients did not have any complaints.ConclusionsPossible reasons for this large number of side effects could be the lack of selection of patients and the fact that the mirror box therapy was paralleled by a conventional rehabilitation approach targeted to the use of a prosthesis. Warnings on the need to select patients, with regard to their psychologic as well as clinical profile (including time from amputation and clinical setting), and possible conflicting mechanisms between mirror box therapy and conventional therapies are presented.

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