On the morning of July 2, 2006, Sgt. Nick Paupore was driving the lead Humvee in a convoy near Kirkuk, in northern Iraq, when a roadside bomb blew off his right leg above the knee.
Within 48 hours, he was at Walter Reed Army Medical Center in Washington, where he has spent the past 18 months recovering. Soon after arriving, Paupore began to feel excruciating pain - in his missing leg.
"It felt like someone was shocking me, like someone was putting an electrode on the back of my ankle," says Paupore, 32.
He tried several painkillers, including methadone, but the pain didn't let up. Then a Navy neurologist, Dr. Jack W. Tsao, asked him to try a new approach that requires patients to move the intact limb while watching the action in a mirror.
Not surprisingly, Paupore was skeptical, and said no thanks.
He's not skeptical now.
Tsao eventually persuaded Paupore to try the therapy. After several weeks the shocks had almost disappeared.
"As soon as I started the treatment, I noticed a remarkable change," says Paupore, who has stopped taking painkillers. "I could see really big improvement, really fast."
No one quite understands how the therapy works, other than a suspicion that it reduces painful nerve impulses, probably in the brain.
Whatever it does, the treatment could revolutionize how doctors deal with phantom limb pain, as the problem is called. There are 2 million amputees in the United States, a number that has increased markedly in recent years with the rise in diabetes. More than 700 U.S. soldiers have lost limbs after being wounded in Iraq and Afghanistan.
Although there are no hard numbers, experts believe phantom limb pain afflicts from 10 percent to 50 percent of amputees. The ailment is often impervious to treatment. Many patients end up on drugs such as Oxycontin or Percocet; as powerful as the medicines are, they seldom work.
A few weeks ago, Tsao, 41, published his results in The New England Journal of Medicine. The study examined 18 veterans, all leg amputees suffering from phantom limb pain.
The soldiers were divided into three groups of six: One group received mirror treatment; another underwent treatment using a covered mirror, while the third didn't use a mirror, but visualized moving the amputated limb.
Those who used an uncovered mirror had significant pain relief. Few in the other groups got relief, and some actually got worse. When the covered-mirror and visualization patients tried the mirror, almost all improved.
