• Stefano Brunelli, Giovanni Morone, Marco Iosa, Cristina Ciotti, Roberto De Giorgi, Calogero Foti, and Marco Traballesi.
• Santa Lucia Foundation IRCCS, Scientific Institute for Research, Hospitalization and Health Care, Rome, Italy. Electronic address: s.brunelli@hsantalucia.it.
• Arch Phys Med Rehabil. 2015 Feb 1;96(2):181-7.

ObjectiveTo evaluate the reduction in phantom pain and sensation with combined training of progressive muscle relaxation, mental imagery, and phantom exercises.DesignRandomized controlled prospective trial with 2 parallel groups.SettingAmputee unit of a rehabilitation hospital.ParticipantsSubjects with unilateral lower limb amputation (N=51) with phantom limb pain (PLP) and/or phantom limb sensation (PLS).InterventionsThe 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.Main Outcome MeasuresThe 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.ResultsThe 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.ConclusionsCombined 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.Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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