Healing Hands MIRAGEs and illusions

Around this time last year, our research at The University of Nottingham unexpectedly stumbled into the media spotlight: “Mind tricks may help arthritic pain; Illusions can halve the pain of osteoarthritis” the headlines read. See the original BBC news article complete with video here.

They were referring to our MIRAGE multisensory illusions box, which can create a powerful illusion that the hand or fingers are being stretched or shrunk. We do this by pulling or pushing on the fingers or hand while a live video image of the hand is stretched or shrunk at the same time. A chance discovery appeared to show that these illusions can reduce the experience of pain in osteoarthritis. Further investigation found that in a sample of 20 OA patients, 85% reported a reduction in pain in their hands (Preston and Newport, 2011). But what is going on here? Perhaps the findings support the idea that, like Chronic Regional Pain Syndrome and Phantom Limb Pain, at least some pain can have its origins in the cortical representation of the body. We can speculate to our heart’s content (and we frequently do), but the truth is we don’t really know so it’s my job to find out what on earth is going on.

The first step was to check that this wasn’t a chance result by running a more rigidly controlled experiment in a bigger sample. I have to say, I had my doubts (I still took the job though, you’ll notice). The original results seemed just a little bit too good to be true, but as I have worked my way through this project and seen the dramatic reactions from many of the participants, there is little doubt left in my mind that there is something wonderful and endlessly fascinating going on here.

The best are the cynical ones. The ones who take one look at MIRAGE and then look back at me with an air of incredulity. “But my pain is real pain”, they protest. “You’re not going to fix it with a computer!” These are my favourite. We go through the motions. They put their hands in the MIRAGE. They look at their hands, they look at me, they look back at their hands. They are poised, ready, just waiting to say “I told you so” and flounce out of the lab – or at least as much as their painful knees will allow. But then I perform the illusion. There’s a moment of baffled silence, and then before I can even ask for a pain rating come the exclamations. Despite their excitement, the participants seem at a loss as to exactly how to describe the feeling they are experiencing. Some have described it as being like a yawn or a morning stretch for their hand, some say that the painful part now feels numb, one described their hand as feeling “oddly warm”, and others seem unable to elaborate any further than “it just feels nice”.

Of course, I wasn’t the only sceptical one: the first thing anyone vaguely clinical asks is, “But isn’t this just a placebo effect?” The original discovery was made completely outside any clinical or treatment setting and so we don’t think it can have been a placebo or contextual effect, but showing that this is not the case is vitally important for novel findings such as ours. For this reason, we implemented a number of control conditions, including some smashing new illusions, such as pulling the hand wider, making the hand unexpectedly disappear and pulling the finger/hand at a slightly different time to seeing the image of the hand get longer. This last one is crucial because the sensory input is the same (you feel a pull and see a stretch), but the illusion that the hand is changing shape is absent because of the lack of integration between seeing the stretch and feeling the pull.

Interestingly, despite our assumption that the pain relief would only last for the duration of the illusion, at least four patients have spontaneously commented that their hand feels much lighter and less painful as they were leaving the room after the experimental session, with one reporting that the pain had still not come back 10 weeks later! The best reaction I have seen was from a participant who walked using a stick and had told me early on in the session that he found it very difficult to grip it properly because his fingers were so stiff and painful. As I handed him his walking stick on his way out, he remarked that he could now grip his stick just fine and it didn’t hurt anymore. As I watched him striding confidently off into the car park, he turned back and said “I better not tell my daughter, or she’ll have me doing the washing up!”

There is still a long way to go before we can fully understand the precise brain mechanisms involved in this seemingly bizarre discovery. But it is moments like these that makes all the cancelled appointments, endless cups of tea, and regular temper tantrums directed at that shambles of a taxi firm suddenly seem worthwhile.

You can read more about MIRAGE and our research at our Mirage Multisensory Illusions Blogspot.

About Helen Gilpin

grey Healing Hands MIRAGEs and illusionsHelen has spent the last 8 months working as primary researcher on the arthritis trials. She is currently studying for an MSc in Cognitive Neuroscience and Neuroimaging at The University of Nottingham, and will be embarking on her PhD from September.

She has a specific interest in the mechanisms underlying the disturbances in body representation seen in various disorders, and wants to particularly focus on the relationship between body representation disturbances and chronic pain.

She likes sports, pub gardens, cheese, and most of all she likes a nice cup of tea! Unfortunately, she has just found out that the funding hasn’t come through for her trip to visit the Body In Mind group in Australia, which is truly devastating news. She has spent the last 24 hours trying to work out the most logistical way to fit herself and all of her worldly possessions into a suitcase in a desperate bid for the southern hemisphere.

Reference

Preston C, & Newport R (2011). Analgesic effects of multisensory illusions in osteoarthritis. Rheumatology, 50 (12), 2314-5 PMID: 21447568

Comments

  1. Anonymous says:

    Hope you get to the southern hemisphere! Enlightening, and entertaining article. If more research papers were written with a hint of humor, I would read more.

    Helen Reply:

    Thanks so much, that’s great to hear! You will be pleased to know that we have managed to scrounge together the money to get me to Australia! I am packing at this very moment.

  2. Helen,
    This is great work. I see many cases of CRPS and other nasty on-going pains and amongst other strategies create illusions with mirrors and photos etc. with interesting effects. I’ll be following your work with interest.
    Richmond

    Helen Gilpin Reply:

    Hi Richmond,
    Thanks for your comment, I would be really interested to hear more about the kind of work you are doing with mirrors and photos. Have you found that the effects you have seen are temporary? Or have you seen any longer lasting effects?
    Helen

  3. It strikes me that there are implications for all kinds of areas, not just for pain management. What I find amazing is that a tiny window can be opened into the ourselves, have our “operating system” ( horrible phrase but can’t think of another one ) exposed, have it tricked. get an tangible affect and then go back to “normal” as if nothing ( other then the pain has changed ) has changed. It suggests we are constantly playing hide and seek with ourselves and maybe pain is when we loose that ability. Or is it only me who thinks this is spooky – in a good way? :)

  4. Helen Gilpin says:

    Hi Mike,
    I think you are right about not only having implications for pain management. The kind of research we are doing definitely makes you think about how easily we can fool the brain into thinking things that logically we know are impossible! It seems that the way we perceive our body is extremely flexible and can be quite dramatically altered by simple manipulations of the sensory inputs received by the brain. As well as make people feel their finger has been stretched to impossible lengths we have also made people feel as if they have an extra hand, or even no hand at all. It seems we are only just scratching the surface with ways in which we can trick the brain – we are developing and often accidentally stumbling across new illusions all the time!
    Helen

  5. Helen,
    Very interesting concept. I do believe that you can rid pain by a diversion, but for 10 weeks very impressive. I am nurse and would love to see more research.

    Helen Gilpin Reply:

    Thanks for your comment, we were expecting the effect to be very temporary so were very surprised when a number of patients seemed to feel the benefits for a long time after the session. We are working on further reserach into how and why this seems to work!
    All the best,
    Helen

  6. Hi Helen
    Brilliant stuff – would be really good to follow up in CRPS, phantoms – other pains & movement disorders.
    I wondered what hardware & software you were using to generate the videos & manipulate them? expensive or something I could get for the clinic?
    Did anyone want to carry on with treatments? – I was thinking of Lorimer’s experiment with a walking illusion for people with Spinal cord injuries where one bought the kit so he could use it at home
    The issue on bory representation in Exp Brain Research makes v interesting reading too – not got through it all yet – Experimental Brain Research. ISSN: 1432-1106, 2010 Jul; Vol. 204 (3), PMID: 20556366
    all the best
    Steve

    Helen Gilpin Reply:

    Hi Steve,

    Thanks for your comment and sorry it’s taken me so long to reply, I was busy organising my trip to visit the Body In Mind team! Yes, quite a few of the arthritis patients wanted to take the machine home. It is a bulky piece of equipment at the moment so not suitable for home use, but hope that in the future we would be able to develop a much smaller version that patients could use at home. A number of people wrote to us and said that when they watched a video clip of the illusory stretching while simultaneously pulling on their own painful hand they experienced some pain relief. So we are looking into developing some kind of online version of the illusion that people could use to ‘top up’ the effect between sessions.

    The MIRAGE is quite expensive at the moment because you can’t buy the components off the shelf and the software behind it is quite complex. We need to know more about why it seems to work before encouraging clinics to get one for themselves. Also, it can be quite tricky to train people to use it properly, as the illusions can be lost at the slightest slip of the hand!

    However, if you did want to know more about getting one (for research at the moment, rather than for treatment) then please get in touch with Dr Roger Newport (who designed MIRAGE) at Roger.Newport@nottingham.ac.uk

    I hope this helps, and thanks again for your encouraging comments!

    Best wishes,

    Helen

  7. Roger Newport says:

    Hello Helen,
    Only me (Roger). I was reading your posts and comments this morning and I was reminded of that time we went to London for the Rockhopper TV gig for World Health News. Do you remember we did the tv shoot and then all the film crew wanted to have a go? That grumpy sound guy wanted us to stretch his finger, but we couldn’t because his hand was so stiff, so we stretched his whole hand and he suddenly started making a fist and claiming it was the first time he could do so since a motorcycle accident three years before. Do you remember that? Very weird, but I believed him. Sometimes I really wish I knew what was going on.

  8. Sarah Wiseman says:

    This is really fascinating. Do you think it would work for people with hand pain due to rheumatoid arthritis? I can’t see why not. I’d be very interested to see how the study progresses. Great article Helen.

  9. Hello,
    I am an occupational therapist from Ohio and I see many patients with orthopedic and neurological conditions causing chronic pain in hands and shoulders. This is such an interesting concept and will be following the research and evidence for a potential treatment option.
    Best of luck,
    Kelly

  10. I have had chronic pain and stiffness in my hands for 3 years. Mine is caused by tigger fingers and early stages of dupuytren’s contracture. Your work sounds fascinating. I had to give up my work as a massage therapist due to pain and have had to change the ways I do my artwork and photography. Is there anybody doing this work in California? Thank you

    Roger Newport Reply:

    Hello Melanie,
    There’s no-one doing this kind of work in California as far as I know I’m afraid. At the moment, we’ve only made a handful of systems for researchers we like and none of those are currently based in California, although that’s not to say that we wouldn’t like them if we met them. It’s also possible that someone out there is doing similar work, but we haven’t heard about it. Unfortunately, Arthritis Research UK didn’t fund us for the next step, so globalisation might take a while longer than we’d hoped.
    Roger.

  11. it’s awesome
    This is very interesting concept but as potential treatment option i can’t rely on placebo effect that long. im willing to know more about the research
    ,

  12. Thanks for bringing this treat research.

    Since it’s a while ago and in the video it was mentioned to see how repeated sessions will affect the pain modulatory effect in terms of duration of decreased pain sensation.
    Are there already new data available?
    Or could you say something about a follow up study?

    Thanks
    Marcel

  13. Helen Gilpin says:

    Hi Marcel,

    Thank you for your interest in our research. We are still investigating the time course of any pain relieving benefits to see whether the illusion might have the potential to relieve pain over more extended periods of time, in which case we could start to think more about future applications for these kinds of illusory therapies in osteoarthritis. We are also hoping to learn more about the brain mechanisms that might be involved. We want to know whether people with osteoarthritis might have a distorted perception or representation of their painful hand, as has been observed in other chronic pain conditions such as CRPS, and what factors might influence the effectiveness of the illusion. There is still a long way to go though before we can really start to unravel the mechanisms behind the baffling effect we are seeing!

    All the best,
    Helen