Would History Be Different If J.F. Kennedy Had Not Suffered From Excruciating Back Pain?

Feature Image of John F. Kennedy on crutches due to severe back pain in 1954 sourced from:



Dear Pain Matters readers,

Much has already been written about John F. Kennedy … What more could I possibly add here??

Having served less than 3 years as US President before being brutally shot down on 22 November 1963, John F. Kennedy is perhaps one of the most famous and beloved presidents in recent history.

Shock waves spread like wildfire throughout the world following his cold-blooded assassination.

(Much as I would have loved to have crossed paths with the iconic President Kennedy, I was not yet born, but rather, still in utero in the warmth of my mother’s womb during his final months.  By the time I was born several months later, the world had already lost one of its greatest leaders of the free world.)

Today’s blog post will focus on John F. Kennedy’s excruciating back pain.

Quoting his brother, Robert F. Kennedy,

AT LEAST ONE HALF of the days that [President Kennedy] spent on this earth were days of INTENSE PHYSICAL PAIN … I never heard him complain … Those who know him well would know he was suffering only because his face was a little whiter, the lines around his eyes were a little deeper, his words a little sharper. Those who did not know him well detected nothing‘ (Pait & Dowdy, 2017).

It was even suggested that President Kennedy’s challenges with Nikita Khrushchev, Premier of Soviet Union, during the Cuban Missile Crisis were nothing in comparison to his deep and personal suffering due to severe back pain. 

Who Was John F. Kennedy?


Born on 29 May 1917, the charismatic John F. Kennedy (JFK) served as the 35th president of the US from 20 January 1961 until his untimely death in Dallas, Texas, on 22 November 1963.

JFK made a genuine effort to make the world a better place.  While addressing discrimination and poverty, JFK also stood for world peace, freedom, safety, civil rights and social justice.

The media played a huge role in portraying JFK as a fit, healthy and energetic young man with strong family values.  For the most part, the media overlooked and/or downplayed JFK’s:

  • Suffering due to excruciating back pain (as well as myriad other health issues including gastrointestinal issues and Addisons disease); and
  • Extramarital affairs and lovers (far too many to count!).

Suppression of the former only adds to the stigma of chronic pain and hinders equitable distribution of resources toward pain research.

Understandably, the latter is unacceptable behaviour for a respectable President.

JFK’s Extramarital Affairs

First , let’s get to the dirt.  After all, JFK’s weakness for beautiful women was part and parcel of who he really was.  He simply adored being in the company of gorgeous and fascinating women.  And yes, many of these women found JFK equally charming and irresistible.

JFK had love affairs with Marylin Monroe, actress Anita Ekberg, East German-born Ellen Rometsch (who was married to a German Air Force sergeant stationed in Washington), Mary Pinchot Meyer (a CIA agent’s ex-wife) and two White House secretaries (Priscilla Wear and Jill Cowen) as well as a very brief fling with Marlene Dietrich (who was 15 years older than JFK).  The list of beautiful women bedded by JFK goes on and on (Browne, 2018).

Having said that, JFK had no intention of ever leaving Jackie Kennedy (née Bouvier), his elegant wife and devoted mother of their 2 beautiful children.


JFK and his future wife, Jacqueline Bouvier (1953)


Given that further details of JFK’s love life are outside the scope of this blog post, let’s move on …

JFK’s Ever Constant Companion – Severe Back Pain, His Back Brace and His Assassination

It has oft been said that if JFK had not suffered from severe back pain, he may never have entered politics in the first place.  JFK’s back pain followed him everywhere, like a dark shadow.

In 1940, JFK failed the physical exams for both the Army and the Navy due to his back pain.

JFK’s severe back pain left him with no other option but to enter politics.

And it was severe back pain that ultimately forced him to wear an orthopedic brace on a daily basis.  Made of cloth with metal rod inserts, JFK’s canvas corset back brace helped support his back that was in constant, unbearable pain.

Ironically, the brace that supported his back was likely the same brace that contributed to his death on 22/11/63 in Dallas, Texas.  Specifically, his back brace prevented JFK from immediately slumping after the first bullet passed though his lower throat and neck.  Instead, JFK’s brace forced his body to remain erect, despite being shot at twice.

‘Thanks’ to his back brace that kept him in an upright position , JFK  remained visible and highly exposed to his assassin.  Like a sitting duck, JFK was in the assassin’s direct line of fire.  Sadly, when the 2nd bullet hit his head, JFK had absolutely no chance of survival.

It was suggested that if JFK had not worn his brace during the assassination, he may have slumped into his chair.  As such, he may have received ‘only’ one bullet to his neck (and not 2 bullets – one to his neck and a second one to his head).  As such, JFK may have slipped away from harm’s way of another bullet.  Thus, it may have been possible to save JFK’s life.

Sadly, despite valiant efforts to try to save his life in hospital, JFK died within half an hour of being shot at twice.

Much has been written about what the world might have been like today if JFK not been fatally shot in Dallas, Texas, on 22 November 1963.  The fact is that no one will never know for sure.

What is finally being revealed is the degree of JFK’s excruciating back pain.

Quoting Dr. Kelman, Internal Medicine and Physiology Specialist,

‘The most remarkable thing was the extent to which Kennedy was in pain every day of his presidency’ (


Severe and ongoing back pain framed JFK’s entire political career from start to finish.  Excruciating back pain affected JFK non-stop since his early years at Harvard until the day he was shot.

It was his severe back pain that led JFK into politics in the first place.  This is because back pain prevented JFK from pursuing other career options. 

In all likelihood, it was severe back pain, and in particular, his back brace for his back pain, that shortened his time as USA’s 35th president and that took him straight into his grave at the tender age of only 46.

As one of the most charismatic and beloved US presidents in recent times, JFK enjoyed many accomplishments during his 1000 days as ‘the most powerful defender of freedom on earth’.

JFK played a huge role in defusing the Cold War between Washington and Moscow by successfully minimising conflict between Cuba and the US in October 1962.  In so doing, JFK played a huge role in preventing a nuclear war at a time when the entire world was at the brink of World War III.  The Soviet missile bases in Cuba were dismantled shortly after the Cuban Missile Crisis ended.  

JFK also founded the Peace Corps, initiated the nuclear test ban treaty and supported the space program (Allison, 2012).

JFK’s Quotes

A review of JFK’s quotes reveals an intelligent man who longed for peace, harmony, freedom, stability, tolerance and justice for mankind.

Here is a sample of JFK’s more famous quotes:

‘… Let every nation know, whether it wishes us well or ill, that we shall pay any price, bear any burden, meet any hardship, support any friend, oppose any foe to assure the survival and the success of liberty. …

… My fellow Americans, ask not what your country can do for you, ask what you can do for your country. …’

(Inaugural Address, 20 January 1961)

‘… For in the final analysis, our most basic common link is that we all inhabit this small planet. We all breathe the same air. We all cherish our children’s futures. And we are all mortal.’

JFK’s above speech is here:


‘As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.’

‘If we cannot now end our differences, at least we can help make the world safe for diversity.’

‘Geography has made us neighbors. History has made us friends. Economics has made us partners, and necessity has made us allies. Those whom God has so joined together, let no man put asunder.’ 

‘We are not here to curse the darkness, but to light the candle that can guide us through that darkness to a safe and sane future.’

‘Once you say you’re going to settle for second, that’s what happens to you in life.’

‘If a free society cannot help the many who are poor, it cannot save the few who are rich.’

‘Conformity is the jailer of freedom and the enemy of growth.’

Above quotes sourced from:  https://www.brainyquote.com/authors/john_f_kennedy

The next citation is quoted from JFK’s best-known international speech.  This powerful speech was translated into German for the 400,000 people who came out to welcome JFK to West Berlin on 26 June 1963.  Considered JFK’s most famous anti-communist speech, it delivered a message of solidarity to West Berlin at the height of the Cold War:

‘… Lass’ sie nach Berlin kommen.  Let them come to Berlin.

Freedom has many difficulties and democracy is not perfect, but we have never had to put a wall up to keep our people in, to prevent them from leaving us. … for [The Berlin Wall] is … an offense against humanity, separating families, dividing husbands and wives and brothers and sisters, and dividing a people who wish to be joined together. …

All free men, wherever they may live, are citizens of Berlin. And therefore, as a free man, I take pride in the words,

‘Ich bin ein Berliner!”


JFK’s ‘Ich bin ein Berliner’ speech (26 June 1963)

Source:  https://www.bbc.co.uk/news/magazine-23029697


Details of JFK’s Severe Back Pain Including 4 Back Operations:

Corticosteroid Treatments During JFK’s Youth

JFK received corticosteroid treatments for intestinal ailments as well as countless treatments for other medical issues throughout his childhood.  These ongoing corticosteroid treatments may have contributed to JFK’s back problems and other medical problems.

Back Injury During Football at Harvard University (1937)

JFK’s back issues and pain may have started in his early 20’s after he suffered a spinal injury while playing football at Harvard University in 1937 (Donald, 2017).

Solomon Islands Boat Collision (1943)

As a 26-year-old lieutenant, JFK was in charge of a crew of 12 on a Navy patrol boat called PT-109 in the Solomon Islands.  On 2 August 1943, JFK’s boat sank after being rammed and cut in half by a Japanese destroyer.  Two (2) crew members died during gas tank explosions.

JFK led all 10 survivors to the safety of a neighbouring island after a 5-hour swim for 5km in the South Pacific Ocean.  JFK also towed a seriously burned sailor by clenching the strap of the injured man’s life vest between his teeth while swimming.

The men were rescued from the South Pacific island several days later after JFK sent a coconut shell seeking help.

The strong impact during the Navy patrol boat’s collision (likely) further aggravated JFK’s lower back pain.

JFK was later awarded a Purple Heart and the Navy and Marine Corps Medal for his ‘extremely heroic conduct’ in the Solomon Islands.

A movie called ‘PT 109’ was released in June 1963, only 5 months before JFK was assassinated in Dallas, Texas.


Four (4) Back Surgeries During 1944 to 1957 


JFK underwent 4 back surgeries during 1944 to 1957.

Specifically, JFK had an unsuccessful discectomy operation in 1944, less than a year after his boat collision.

Ten years later, JFK underwent a failed spinal fusion via metal plate implant.

Sadly, both spinal operations led to even more pain and complications, with the second surgery almost leading to JFK’s death.

A 3rd back operation was done to remove the metal plate that had been unsuccessfully implanted only months earlier.

A 4th and final back operation was done in 1957 to drain and surgically remove an abscess that had formed along the surgical scar on JFK’s lower back.

Details below.

JFK’s 1st Back Surgery (23 June 1944)

JFK underwent his first spine surgery involving a left L4-L5 laminotomy* and L5-S1 discectomy** on 23 June 1944.

Two (2) weeks later, JFK’s excruciating back pain returned, together with severe muscle spasms in his lower back while walking.

Highly disappointed with the results of this back operation, JFK wrote:

‘In regard to … my operation … I think the doc should have read just one more book before picking up the saw’ (Pait & Dowdy, 2017).

JFK relied on crutches, wore a back brace, had daily physiotherapy and took pain medication for the next 10 years (when not in public) (Staedter, 2011; Volpe, 2017).

JFK’s 2nd ‘Promising’ Back Surgery … The One That Nearly Killed Him (21 October 1954)


In 1954, JFK (by now a Senator) was advised that a sacroiliac and lumbosacral fusion surgery might stabilise his lower back.  Specifically, a spinally-implanted metal plate would fuse his vertebrae together.

On the other hand, if he chose not have lumbosacral metal implant and fusion surgery, JFK could end up in a wheelchair for life.  

Due to his never-ending back pain, JFK decided to go ahead with the lumbosacral fusion surgery.  In his mother’s words,

‘Jack … told his father that even if the risks were fifty-fifty, he would rather be dead than spend the rest of his life hobbling on crutches and paralysed by pain.’

(Pait & Dowdy, 2017).

Guess what happened anyway?

After his ‘promising’ back operation, JFK still spent most of his short life hobbling around on crutches, paralysed by pain, only to be ruthlessly shot dead by a crazy gun man.

As he once stated, ‘Life is unfair.’  

Details of the 2nd ‘Promising’ Back Surgery

Although radiographs showed that the (previously operated on) L5–S1 disc was significantly reduced by ~70%, there were no compression fractures nor congenital abnormalities in the vertebrae bone.  

Nevertheless, on 21 October 1954, the renowned Dr. Philip Wilson Sr surgically attached a curved metal plate onto the spinous processes*** on JFK’s vertebrae.  Made of a cobalt-chromium alloy, the metal plate was affixed via 3 transverse locking bolts (plus some wire).  Once firmly secured into position, the metal plate stretched from L5 in the lower back to S2 in the sacrum****.

This metal plate was also called a Wilson plate by its developer, being none other than JFK’s orthopedic surgeon, Dr. Philip Wilson Sr.

(See paper by Pait & Dowdy, 2017 that includes images of a Wilson plate.)

Disastrous Post-Surgery Results Including Septicaemia, Staphylococcal Infection and Coma

Immediately following back fusion surgery on 21 October 1954, JFK knew something had seriously gone wrong.  JFK’s medical issues including back pain went from bad to worse. 

JFK developed high temperatures, urinary tract infection and septicaemia before falling into a coma.

A priest was urgently called to his bedside to deliver the last rites of the church.  Those nearest and dearest to JFK were no longer confident that he would survive.

When JFK finally did awaken from his coma, a serious staphylococcal infection had developed at the site of incision.

Quoting JFK’s friend (in italics), there was an ‘open, gaping, very sickly looking hole’.

Quoting another friend, ‘the area where they cut into his back never healed.  It was oozing blood and pus all the time.  It must have been painful beyond belief … It was an open wound that seemed to be infected all the time.  And now and then a piece of bone would come out of the wound.  His pain was excruciating’ (Pait & Dowdy, 2017).

Meanwhile, public awareness of JFK’s post-operative dramas was kept to an absolute minimum.

Survive he did … but only just (Pait & Dowdy, 2017).

JFK’s 3rd Back Surgery (10 February 1955)

It would be another 6 – 7 months before JFK was finally able to return to his duties as a Senator in May 1955.

However, prior to returning to work, JFK had to endure yet another back operation.  This 3rd back operation was done to surgically remove the Wilson plate that had been implanted only months earlier.  Sadly, a life-threatening abscess had formed around this metal plate.

Post-3rd Back Surgery

JFK remained heavily medicated throughout failed back surgery in 1954 and the follow-up surgery in 1955 (that reversed its disastrous results).  JFK was hospitalised no less than 9 times during the next 2 years.  Needless to say, JFK’s severe back pain continued to haunt and torture him.

JFK continued to wear his back brace and use his crutches (the latter, when not in public view).

JFK received alternative treatments including multiple hot baths daily, swimming, massage therapy, muscle strengthening exercises including lifting weights and heat therapy.  JFK also commenced procaine trigger point injections for myofascial pain (more later).

JFK’s 4th and Final Back Surgery (13 September 1957)

A large Staphylococcus aureus-induced abscess was discovered on JFK’s lower back along the site of the surgical scar almost 3 years after his disastrous back surgery in 1954.  This abscess had to be drained and surgically removed during a 4th and final back surgery in 1957 (Dallek; Baggaley, 2017; DeCosta-Klipa, 2017; Pait & Dowdy, 2017; Volpe, 2017).


Prelude to a Philosophical Question

Why did JFK have to hide his suffering due to severe back pain from the media and the voters?

Quoting historian David Nasaw,

[Voters] largely knew nothing of his illnesses and chronic pain … They were instead presented with the portrait of a superbly healthy young man, an athlete, a veteran, a smiling, affable, dynamic, energetic, youthful, handsome American with a smiling, healthy, athletic wife, parents, brothers, and sisters.’  

Quoting Justin T. Dowdy, MD,

‘The most surprising finding … was the overall amount of severe pain JFK endured throughout his short life and, frankly, how he was able to hide his pain and medical ailments from the general public so well’ (Science Daily, 2017, for Pait & Dowdy, 2017).

In actual fact, JFK would scream out in pain during injections of procaine (up to 8 injections at a time) to numb the muscles deep inside his painful back.  JFK literally had 100’s, if not 1,000’s, of procaine injections from 1955 to 1961 (Pait & Dowdy, 2017).

JFK would take up to 8 different kinds of medication a day including a wide assortment of painkillers (e.g. codeine, Demerol, narcotics, methadone, ethyl chloride spray, methamphetamine derivatives, hydrocortisone, anti-anxiety drugs, stimulants (Ritalin), sleeping pills and hormones).  The list goes on and on.

JFK could not even put a sock or a shoe on his left foot without assistance.

Despite desperately wanting to, JFK could not even pick up his own children.

While JFK never complained openly about his back pain, he once stated (as already noted), ‘Life is unfair.’  

Despite JFK also adding, ‘Some people are sick and others are well’, the latter was usually suppressed in media. 

Instead, the public was led to believe that JFK’s back problems were caused by war injuries suffered while in the line of heroic duty when his boat, PT-109, was sunk in World War II.

Meanwhile, at least 10 boxes of X-rays were done in a desperate attempt to find the true cause for JFK’s back pain (DeCosta-Klipa, 2017).


Without a shadow of a doubt, JFK was the most powerful man in the free world from 1961 until his cold-blooded assassination in 1963.  JFK remains one of the most influential and popular presidents in American history.

Not only are 100’s of places in the US named after JFK, but 72 streets and locations in (West) Germany also received Kennedy’s namesake following his death.  Many other countries in the world also renamed streets, parks, schools and other places after JFK.

By renaming places and streets after him, JFK’s memory lives on forever (Kirk et al, 2013; Milbradt, 2017, in German).

A Philosophical Question

Would public knowledge of his severe and ongoing back pain have diminished, and even nullified, his chances of being voted as the US’s 35th president?

If yes, why??

How far have we come today?  Are today’s leaders ‘allowed’ to admit to suffering from chronic pain (if any)? Or would this be viewed as a sign of weakness that could only lead to career suicide?

On the other hand, what would happen if our great leaders were ‘allowed’ to openly discuss any sufferances due to chronic pain?  

Wouldn’t this lead to greater awareness of the problem of pain in our global community?

If yes, wouldn’t this lead to increased allocation of resources for pain research?  

If yes, wouldn’t this be a good thing for humanity?

I hope you enjoyed today’s blog post on President Kennedy and his severe back pain.

Sabina Walker, Blogger of Pain Matters (in WordPress)



* Laminotomy involves the surgical removal of a large part of the lamina (i.e. normal bone) from the vertebra.  This enables the surgeon to access the herniated disc.

** Discectomy involves the surgical removal of the herniated disc in the spine.

*** Spinous processes are bony projections (ridges) off the back of each vertebra that can be felt through the skin.

**** The sacrum is the triangular bone at the bottom of the spine.



(1) Dallek, Robert. The Medical Ordeals of JFK. The Atlantic.


(2) DeCosta-Klipa, Nik. JFK had 5 brushes with death before that open-air Dallas car ride. Boston (22 May 2017).


(3) Altman & Purdum. In J.F.K. File, Hidden Illness, Pain and Pills. 


(4A) Evans, Stephen. John F Kennedy: How ‘Ich bin ein Berliner’ gave a city hope. BBC News (25 June 2013).


(4B) John Fitzgerald Kennedy – Ich bin ein Berliner Speech, June 26, 1963.


(5) Volpe, Kristin Della. John F. Kennedy’s Chronic Back Pain Conflicts Revealed. Spine Universe (27/12/17).


(6) Staedter, Tracy. How John F. Kennedy’s Back Pain Affected His Life and Death. Live Science (11 July 2017).


(7) Baggaley, Kate. Why doctors are still studying JFK’s chronic back pain – Did his back trouble help kill him? Popular Science (18 July 2017).


(8) Allison, Graham. 50 years after Cuban missile crisis: closer than you thought to World War III. The Christian Science Monitor (


(9) John F. Kennedy. History.



An App called MUSIC CARE© for Relief of Pain and Anxiety

Feature Image sourced from:


Dear Pain Matters blog readers,

Here’s some exciting news:

An App called MUSIC CARE© offers personalised music therapy to help with pain, anxiety, depression, sleep dysfunction, medication over-use and other health issues.  MUSIC CARE can be used in a hospital setting, at home or in an alternate quiet and relaxing environment (Guétin et al, 2016).

This App allows the patient to select their own favourite music genre (e.g. classical, world, modern, electronic). It also allows the user to choose a desired personal goal (i.e. improve sleep, obtain pain relief or become awake).

Patients welcome the distraction of being able to listen to their preferred music genre while also undergoing a medical intervention.  Patients even bring their favourite headphones in anticipation of MUSIC CARE during their stay in hospital.

The self-selected music sessions help soothe, relax and calm patients as well as reduce stress and anxiety while in a safe, relaxing and peaceful environment.

If the patients are relaxed, it leads to a calmer situation, overall.  It helps to optimise the sedation procedure and ensure that the medical intervention runs as smoothly as possible.

The MUSIC CARE App is based on pre-recorded music sessions by talented musicians.  Specifically, music sessions are created in line with the medical ‘U-Sequence’.  This U-Sequence comprises 3 phases, being:

  • A Stimulating Rhythm – a phase dedicated to a conscious state prior to sedation;  
  • A Slow Rhythm – a phase dedicated to a relaxed state during sedation or local anaesthesia; and
  • A Moderate Rhythm – a phase dedicated to an awake state, post-sedation or post-local anaesthesia.

According to Dr Boccara, Chief of Anesthesia at The American Hospital of Paris, the MUSIC CARE App can be used:

  • Prior to intervention;
  • During local anaesthesia and sedation; and
  • During recovery, both in hospital and at home.

When reviewing brain activity during MUSIC CARE, either clinically or via electroencephalography, there is a gradual reduction in brain activity during sedation that occurs in synchronicity with the rhythm of the music itself.

In fact, the Slow Rhythm stage of each music session can influence brain activity in the same way that sedation may affect activity in the brain.  In other words, it is as if the patient is sedated (when they may not be).  

Furthermore, heart rate and blood pressure visibly decrease as well as acute pain and anxiety levels in patients who use MUSIC CARE, compared to those who do not.

While the medical team can still talk to the patients (if necessary), the patients can otherwise feel completely distracted, ‘switched off’ or ‘tuned out’ during the Slow Rhythm phase of a MUSIC CARE session.  During this Slow Rhythm phase, patients lose all sense of time and space.

While drifting off into ‘la-la-land’, a patient may believe that an intervention lasted only a few minutes when in actual fact, it may have taken 45 to 60 minutes.  The effect is somewhat comparable to hypnosis.

For more details, see 5-minute video called ‘The American Hospital of Paris using the MUSIC CARE method’ (below):

I hope you enjoy watching this video as much as I did!

More details are available on MUSIC CARE’s website:


Please note that while available in English and French, and while downloadable to a smartphone, the music therapy-based MUSIC CARE App is only available to licensed healthcare professionals and patients who have a partner code from their healthcare providers.

Musically yours,

Sabina Walker

Blogger, Pain Matters (in WordPress)


(1) MUSIC CARE’s website:



(2) Guétin S, de Diego E, Mohy F, Adolphe C, Hoareau G, Touchon J, Thayer JF, Koenig J. A patient-controlled, smartphone-based music intervention to reduce pain—A multi-center observational study of patients with chronic pain. European Journal of Integrative Medicine (2016).




Smearing Pain Away with Ambroxol 20% Cream

Feature Image of Ambroxol molecule sourced from:


Dear Pain Matters readers,

Treatment via topical* Ambroxol* 20% cream may offer significant pain relief from severe and localised nerve pain conditions including:

  • Complex regional pain syndrome (CRPS);
  • Trigeminal nerve pain;
  • Postherpetic nerve pain;
  • Phantom limb pain;
  • Deafferentation pain;
  • Post-surgical nerve pain;
  • Nerve pain in both feet; and
  • Multifocal neuropathy.

Prepared by a local pharmacist, topical Ambroxol 20% cream comprises:

  • Ambroxol;
  • Dimethyl sulfoxide; and
  • Linola cream (that includes linoleic acid).

Specifically, 50.0 g of topical Ambroxol 20% cream contains Ambroxol (10.0 g), dimethyl sulfoxide (5.0 g) and Linola cream (up to 50.0 g for the total mixture) (Kern & Weiser, 2015).


Ball-and-stick model of Ambroxol molecule sourced from:


As a strong local anaesthetic, Ambroxol works by blocking sodium channels, and in particular, the TTX-resistant (TTX-r) Nav1.8 sodium channel.  In fact, Ambroxol is 40 times more potent than lidocaine.  Preferentially expressed in nociceptive C-fibres, Nav1.8 may be upregulated during inflammation and pain (Weiser, 2006).

Topical Ambroxol for Complex Regional Pain Syndrome 

Eight (8) patients who suffered from CRPS for less than a year received topical Ambroxol 20% cream, together with standard treatments.

Topical Ambroxol resulted in many therapeutic benefits including:

  • Less spontaneous pain and pain during movement (N=6);
  • Less allodynia and hyperalgesia (N=6 and N=7, respectively);
  • Decreased swelling and skin reddening (N=7 and N=4, respectively) as well as enhanced skin temperature (N=4); and
  • Improved motor dysfunction (N=6).

In summary, topical Ambroxol 20% cream may be a useful treatment option for CRPS (Maihöfner et al, 2018).

Topical Ambroxol for Trigeminal Nerve Pain 

Five (5) patients with trigeminal neuralgia suffered pain attacks while 3 of them also endured spontaneous pain.  Their facial pain levels ranged from 4 to 10 (out of 10, using the Numerical Rating Scale; NRS).

The good news:

All 5 patients enjoyed significant pain reductions including decreased pain attacks following application of topical Ambroxol 20% cream (in addition to standard treatment).  Specifically, their pain levels dropped between 2 to 8 points (out of 10, using NRS) within only 15 to 30 minutes following topical Ambroxol treatment.   Pain relief lasted 4 to 6 hours.

Pain was completely eliminated in one patient after a week of topical Ambroxol treatment, while 2 patients were able to reduce their medication intake.

There were no adverse effects nor skin reactions.

In summary, topical Ambroxol 20% cream can lead to significant pain relief from trigeminal neuralgia within 15 to 30 minutes following application thereof onto painful areas (Kern et al (2019).

Topical Ambroxol for Severe Chronic Pain – 7 Successful Cases


A German study reviewed the effects of topical Ambroxol on 7 patients (2 females; 5 males) with severe nerve pain.

Specifically, 2 patients had postherpetic nerve pain while the remaining 5 suffered from phantom limb pain, deafferentation pain, post-surgical nerve pain, nerve pain in both feet and multifocal neuropathy.  Their average pain levels ranged from 4 to 6, while their maximum pain reached 6 to 10 (NRS).

Four (4) patients had tried lidocaine 5% without success, while a 5th patient did not benefit from capsaicin 8%.

The good news:

All 7 pain patients enjoyed pain relief within 5 to 30 minutes after topical application of Ambroxol 20% cream onto painful areas (details follow).  The topical Ambroxol-evoked pain relief included reduced pain attacks and lasted 3 to 8 hours.  Four (4) patients had improved mobility, better sleep and other benefits.

There were no adverse effects nor skin changes during application of topical Ambroxol, even 4 years later.

Case 1 – Local Nerve Pain in Both Feet

A male patient named John** (born in 1942) suffered from nerve pain in both forefeet despite topical lidocaine 5 % plasters and other pain treatments.

The goods news:

John first started using topical Ambroxol in June 2011.  Within 5 minutes, the stabbing pain and allodynia (8/10) in both of his feet disappeared completely for more than 8 hours.  Furthermore, John was able to significantly reduce his Gabapentin intake and discontinue opiates altogether.

At follow-up after 4 years, John continued to be successfully treated with topical Ambroxol.  As a result, John was able to enjoy walking and gardening again.

Case 2 – A Double Amputee with Cold Phantom Limb Pain

Both of Joe’s** lower legs were amputated due to peripheral arterial occlusive disease and diabetes mellitus.

Joe regularly suffered severe cold phantom limb pain (7–9, out of 10) that shifted from his missing toes to the balls of his phantom feet.  These spontaneous bursts of pain usually lasted anywhere from a few minutes to many hours and even affected his sleep.

Joe’s pain treatment including opiates and anticonvulsants failed to offer pain relief.

One day, 15 minutes after applying topical Ambroxol 20% cream onto his stumps, Joe finally found significant relief from his cold phantom limb pain.  This pain relief that also included warmer phantom limbs lasted several hours.

At the 11-month follow-up, Joe continued to enjoy pain relief without skin changes nor other side effects thanks to regular application of topical Ambroxol 20% cream onto his stumps.

Case 3 – Chronic Knee Pain Following Total Knee Replacement 

After a total knee replacement in November 2010, Jan** (58) suffered ongoing nerve pain including allodynia and hyperalgesia in her knee.

Despite pain treatments including Tapentadol (that replaced Buprenorphine), lidocaine patches and capsaicin 8 % plasters, Jan was unable to find pain relief.

One day, within only 15 minutes following application of topical ambroxol 20% cream to her painful knee, Jan finally found (quoting) ‘clear pain relief’!  The burning and stabbing in her knee was significantly reduced while the ‘raging feeling’ in her knee was almost gone.

At follow-up almost one year later, Jan continued to enjoy substantial pain relief for 4 – 6 hours following repeated application of the topical ambroxol 20% cream.  Specifically, her average knee pain levels dropped from 8 down to 4 (and sometimes even lower, down to 1).  There were no skin changes nor other side effects.

Case 4 – Deafferentation Pain after a Motorbike Accident

A patient (38) named Allan** suffered deafferentation pain in his  left arm including allodynia in his hand and forearm due to a plexus lesion caused by a motorcycle accident in 1997.

Despite a nerve graft, ketamine, gabapentin, a lidocaine infusion and lidocaine plasters as well as mirror therapy, Allan’s pain was severe and relentless.

The sedative effects of amitriptyline treatment were intolerable, as were the psychoactive effects of cannabis.

Trigger point treatment and Tapentadol were also not tolerated.

Despite being on pregabalin and duloxetine, Allan suffered ‘burning pain’, ‘crushing underlying pain’ and ‘shooting tingling pains’, with pain levels ranging from 4 to 8 (of 10).

One day, topical Ambroxol 20% cream was applied over Allan’s pectoral muscle.

Guess what happened next?

The shooting and tingling pains dropped from 8/10 to 4/10!

Substantial pain relief would kick in within 15 minutes and last for 4 to 6 hours following regular application of topical Ambroxol 20% cream.  Allan’s sleep improved and his spasms and cramps disappeared.

Unfortunately, the ‘deep underlying pain’ persisted despite topical Ambroxol 20% cream treatment (and pregabalin and duloxetine).

Case 5 – Postherpetic Nerve Pain on Chest

A male patient named Pete** (55) suffered postherpetic nerve pain (5/10) and allodynia on the right side of his chest.

Whilst lidocaine plasters helped relieve his pain, the plasters could not cover all the painful skin regions.

One day, Pete added topical Ambroxol 20% cream to his pain management protocol.  Analgesia occurred in only 30 minutes after topical application of Ambroxol cream to areas not covered by lidocaine patches.  Pain attacks reduced from 6/10 to 4/10 and this pain relief was sustained for 4 to 6 hours. There were no skin reactions nor other side effects, even after 3 years of Ambroxol cream treatment.

Case 6 – Multifocal Neuropathy

A male patient named Sam** suffered nerve pain in the arch of his left foot as well as multifocal neuropathy*** caused by vasculitis.  Sam’s persistent pain including severe pain attacks (8/10, especially in the evenings and at night) prevented him from engaging in activities.

Although amitriptyline drops helped with sleep, lidocaine patches, peripheral analgesics and Tilidine did not offer pain relief.

In December 2013, Sam tried topical Ambroxol cream for the first time.

The good news:

Within only 15 minutes of topical Ambroxol application in the evening, Sam’s nerve pain levels were significantly reduced from 6/10 to 2/10.  This pain relief lasted more than 6 hours, hence improving his sleep.  Sam was also able to stop using Zolpidem.

After 4 months of topical Ambroxol cream treatment, Sam’s underlying pain during the daytime had almost vanished.

At the 17-month follow-up, Sam continued to obtain pain relief from topical Ambroxol treatment without any skin reactions nor other side effects.

Case 7 – Trigeminal Postherpetic Nerve Pain

A 91-year old female patient named Edith** suffered facial nerve pain up to 8/10 and poor sleep after a zoster infection of the maxillary branch of the left trigeminal nerve in June 2014.

While lidocaine patches offered pain relief, there were bad skin reactions.

Edith finally enjoyed pain relief and better sleep after starting topical Ambroxol 20% cream.

Repeated application led to consistent pain relief including a ‘calmer’ cheek within only 15 minutes, as confirmed at the 11-month follow-up.

There were no adverse effects.


The Nav1.8 sodium channel plays a key role in certain pain mechanisms while TTX-sensitive sodium channels contribute to others.  Sodium channels including TTX-r Nav1.8 are upregulated during inflammation in many pain conditions (e.g. trigeminal neuralgia).

As a strong sodium channel blocker, Ambroxol preferentially blocks TTX-r Nav1.8.  Specifically, a study confirmed that Ambroxol blocked resting TTX-r sodium channels more potently than lidocaine, mexiletine or benzocaine.  Thus, Nav1.8-mediated nerve pain may be blocked by topical Ambroxol (Weiser, 2006).  Similar results were reported by other studies (Gaida et al, 2005; Hama et al, 2010; Moon et al, 2012).

Another local anesthetic called Mepivacaine also blocks Nav1.8, contrary to Bupivacaine that inhibits TTX-sensitive sodium channels instead (Leffler et al, 2010).

Warning: Possible Adverse Effects of Ambroxol

Like most drugs, Ambroxol can cause serious side effects (Kreicas, 2016; Combalia et al, 2017).

Studies reported that adverse effects usually arose after systemic intake (e.g. oral ingestion), as opposed to topical application, of Ambroxol (Monzón et al, 2009).


Ambroxol is a strong local anaesthetic and peripheral analgesic that selectively targets and potently blocks the TTX-r Nav1.8 that may play a role in many nerve pain conditions.

As such patients with localised nerve pain may obtain significant pain relief from topical Ambroxol cream that preferentially targets TTX-r Nav1.8.

Topical Ambroxol is non-addictive and relatively safe for long-term use (subject to medical supervision) (Kern & Weiser, 2015; Kern & Weiser, 2015 (Poster 239)****; Casale et al, 2017).

Now that’s a good way to cover up localised nerve pain!

Sabina Walker

Blogger, Pain Matters (in WordPress)


* Topical means locally through the skin.

* Ambroxol is sometimes called na872.

** Not his/her real name.

*** Multifocal neuropathy is sometimes called mononeuritis multiplex or mononeuropathy multiplex.

**** Poster 239 by Kern & Weiser (2015) outlines several more successful cases not mentioned above.  See Poster 239 for further details.


Clinical Papers

Topical Ambroxol for Complex Regional Pain Syndrome 

(1A) Maihöfner et alSuccessful treatment of complex regional pain syndrome with topical ambroxol: a case series. Pain Management (


Topical Ambroxol for Trigeminal Nerve Pain  

(1B) Kern et al. Topical Ambroxol 20% for the Treatment of Classical Trigeminal Neuralgia – A New Option? Initial Clinical Case Observations. Headache The Journal of Head and Face Pain (17 January 2019);


Topical Ambroxol for Severe Chronic Pain – 7 Successful Cases

(1C) Kern & Weiser. Topical ambroxol for the treatment of neuropathic pain. An initial clinical observation. [in German: Topisches Ambroxol zur Behandlung neuropathischer Schmerzen.] Schmerz (20 November 2015); 29 Suppl 3: S89-96.

doi: 10.1007/s00482-015-0060-y


(1D) Kern and Weiser. Topical Ambroxol for the treatment of neuropathic or severe nociceptive pain – First case reports. 9th Congress of the European Pain Federation (EFIC) (Sept 2015: Vienna); Poster 239.

doi: 10.13140/RG.2.2.35671.27041


Related Papers and Articles

(1E) Casale et al. Topical Treatments for Localized Neuropathic Pain. Curr Pain Headache Rep (2017); 21(3): 15.



(2A) Weiser, T. Comparison of the effects of four Na+ channel analgesics on TTX-resistant Na+ currents in rat sensory neurons and recombinant Nav1.2 channels.  (13 March 2006); 395(3):179-84.


(2B) Gaida et al. Ambroxol, a Nav 1.8-preferring Na(+) channel blocker, effectively suppresses pain symptoms in animal models of chronic, neuropathic and inflammatory pain. Neuropharmacology (2005); 49: 1220–1227.

doi: 10.1016/j.neuropharm.2005.08.004.


(2C) Hama et al. Antinociceptive effect of ambroxol in rats with neuropathic spinal cord injury pain. Pharmacol Biochem Behav (2010); 97: 249–255.

doi: 10.1016/j.pbb.2010.08.006


(2D) Leffler et al. Block of sensory neuronal Na+ channels by the secreolytic ambroxol is associated with an interaction with local anesthetic binding sites. Eur J Pharmacol (2010)630:19–28.

doi: 10.1016/j.ejphar.2009.12.027


(2E) Moon et al. The differential effect of intrathecal Nav1.8 blockers on the induction and maintenance of capsaicin- and peripheral ischemia-induced mechanical allodynia and thermal hyperalgesia.  (Jan 2012); 114(1): 215-23.

doi: 10.1213/ANE.0b013e318238002e.


(2F) Weiser, Thomas. Ambroxol: a CNS drug?. CNS Neurosci Ther (2008); 14(1): 17-24.

doi 10.1111/j.1527-3458.2007.00032.x.


(2G) Weiser, Thomas. Nav1.8 channel blockade as an approach to the treatment of neuropathic pain. Drugs of the Future (July 2006); 31(7); 597.



Warning: Possible Adverse Effects of Ambroxol

(3A) Kreicas, Leonard. Topical ambroxol possible treatment of neuropathic pain. Nerve Neuropathy (1/6/2016).


(3B) Combalia et al. Stevens–Johnson syndrome probably induced by ambroxol. CED (24 April 2017); 42(4): 465-467.



(3C) Monzón et al (2009). Ambroxol-induced systemic contact dermatitis confirmed by positive patch test. Allergologia et immunopathologia (2009); 37: 167-8.

doi: 10.1016/S0301-0546(09)71730-6


(3D) Benstetter, Monika. Ambroxol and bromhexine expectorants: safety information to be updated. European Medicines Agency (27/02/2015).







Mirror Therapy for Relief from Phantom Limb Pain Inspired By Professor Ramachandran

Feature Image of Professor Ramachandran sourced from:


Thanks to Professor Ramachandran’s inspiring research into mirror therapy, the world is now a better place for many amputees with phantom limb pain and other patients!

For related blog posts, see:




Dear Pain Matters blog readers,

This blog post discusses:

  • A clinical trial involving mirror therapy;
  • Two (2) amputees who had successful mirror therapy for phantom limb pain; and
  • Professor V.S. Ramachandran’s ground-breaking research into mirror visual feedback via mirror therapy.

Phantom pain affects at least 90% of all amputees.  It includes a myriad of painful sensations including the following:

  • The limb feels frozen in an awkward position;
  • Burning;
  • Stabbing;
  • Shooting; or
  • Electrical shocks.

The good news is that mirror therapy (aka mirror visual feedback) may offer a cheap and effective treatment option for some amputees with phantom limb pain and other pain sufferers.


Sgt. Wallace Fanene’s Story  

Sgt. Wallace (‘Wally’) Fanene, a 25-year old Samoan in California, was severely injured on September 8, 2007, while serving in Iraq.  He lost both his right arm and his right leg in an improvised explosive device (IED) blast.  At first, Wally did not feel any pain, although he had a burning sensation in his injured legs.  In his words,

‘I knelt down on a landmine;  I sat on it.  I knew my leg was gone right when I was hit, but I didn’t feel any pain, and I didn’t know about my arm.’

Things got even weirder at the hospital when Wally asked his wife to scratch his bandaged right hand to relieve itching.  What Wally did not realise was that his lower right arm was also missing!

[My wife] told me my arm was gone. We argued about that for five minutes. I mean, I could feel it.’

It was at the hospital when the pain kicked in big time, even affecting his sleep.  There were nails in his phantom toes as well as needles and a knife-like pain in his missing leg.

Wally added,

‘It was the most excruciating pain in my life.’


Source: https://www.sandiegoreader.com/news/2008/jul/09/cover/

Enter Mirror Therapy  

Not knowing what to expect, Wally enjoyed immediate pain relief as soon as he started mirror therapy.  

In Wally’s words,

‘I was sceptical at first, but then I said, what the heck. So we tried it and [mirror therapy] worked right away. The pain just stopped. Four hours later the pain came back again, and again the mirror helped right away … 

… The pain still comes back, but it’s nowhere as bad as it was.  It comes back several times a day.  But if [the phantom limb pain] starts to bother me, I use the mirror.’


Wallace Fanene, double amputee, and his wife




Inspired by Professor Ramachandran’s ground-breaking research into mirror visual feedback in the mid-1990’s, Jack Tsao, Neurologist, offered mirror therapy for his patients who suffered phantom limb pain.

Soon after, Tsao set up a clinical trial involving mirror therapy for phantom pain at the Uniformed Services University in Maryland.

Specifically, 22 lower limb amputee patients with phantom pain from Walter Reed Army Medical Center (WRAMC) were randomly allocated to 1 of 3 groups.  Four (4) patients were unable to complete this study.

The 1st group (N=6) received mirror therapy.  The remaining 2 groups underwent covered mirror treatment (N=6) and mental visualisation (N=6).

Each group was instructed to do their assigned therapy for 15 minutes daily for 4 weeks.

This study found that ALL 6 amputees in the first group who received mirror therapy enjoyed reduced phantom limb pain after one month!  Some even experienced complete relief from phantom pain after mirror therapy.

In comparison, half of the 2nd group who received covered mirror treatment and 2/3 of the 3rd group who performed mental visualization exercises had increased pain after 1 month.

Nine (9) amputees from the 2nd and 3rd groups were subsequently re-assigned to classical mirror therapy for 4 weeks.  Eight (8) of these 9 amputees (89%) enjoyed less pain thereafter.

The first group performed 4 additional weeks of mirror therapy, totalling 8 weeks.  This resulted in further improvements for all 6 participants.  

Jack Tsao, Neurologist, said that the results ‘astounded me … I didn’t expect [the results] to be that good.’

Mirror therapy is now available at 3 US military amputee centres including WRAMC as well as other locations for amputees and patients with other painful conditions (Chan et al, 2007; Dobyns, 2008).

Nick Paupore, Amputee and Participant in Above Trial

Nick Paupore (32), a participant in the aforementioned trial, enjoyed significant relief from excruciating phantom pain following mirror therapy.

Nick lost his lower right leg in Iraq when a roadside bomb hit his vehicle.  While he felt a burning sensation in the back of his legs, Nick did not feel any pain.  Unfortunately, the blast tore out a chunk of his leg including 15cm to 20cm of an artery that almost caused him to bleed to death.

At the hospital, Nick suffered excruciating phantom pain in his missing leg 5 – 6 times an hour, with each bout of pain lasting up to a minute.  As he screamed and dry-heaved, the searing shock raced from the missing sole in his foot up the back of his phantom calf and into his thigh.

Quoting Nick,

‘I was laying in bed and it just, all of a sudden, it felt like I was getting shocked.  I called the nurse, ’cause I was like, ‘What’s going on?’  

The nurse told Nick that it was likely his phantom pain.

Nick continued,

‘All of a sudden, it was like someone kept turning on and off the Taser, and my whole leg started twitching. … I sat up, and I was holding on to my stump, and it just wouldn’t stop.’

‘It was like sticking my finger in a light socket. … getting electrocuted.’

‘… the [phantom] pain was driving me insane.’

And now for the good news:

Nick was almost pain-free after mirror therapy for a month.  Furthermore, he no longer needed pain medication 5 months later.

Jack Tsao

Jack Tsao, Neurologist, with Nick Paupore during mirror therapy


Quoting Tsao, Neurologist,

‘The difference is like night and day … To see him walking, he’s able to drive his car; he works downtown; I mean, that is incredibly gratifying!’ (Burgess, 2008; Young, 2008).



Professor Ramachandran did research in the mid-1990’s based on amputees who had lost their limbs many years earlier.  His studies led to mirror therapy as a pain treatment option for phantom limb pain and other painful conditions.


Neuroscientist V.S. Ramachandran

Source: https://greatergood.berkeley.edu/article/item/do_mirror_neurons_give_empathy

Many ground-breaking research findings were reported by Ramachandran including:

(1) An amputee named ‘D.S.’ lost his left arm 9 years ago.  His phantom arm felt as if it was ‘frozen … in a cement block’.  Ramachandran offered mirror therapy involving bilateral mirror-symmetric movements.  During this therapy, D.S. felt movement in the muscles and joints of his phantom arm while looking at his intact arm in the mirror.

When Ramachandran removed the mirror, D.S. was no longer able to feel his phantom arm move.  In his words, ‘It feels frozen again.’   

This experiment demonstrates the importance of visual feedback via mirror therapy in restoring movement in ‘frozen’ phantom limbs.  This movement may even be a prerequisite before phantom limb pain can be reduced or eliminated altogether.

(2) A left arm amputee known as ‘R.T.’ (55) suffered a paralysed phantom arm.  His left hand often had clenching spasms with ‘fingernails digging into the palm’.

Mirror visual feedback was done to provide an illusion of a restored left arm.  The reflection of his intact right arm in the mirror provided the visual feedback that R.T. desperately needed before he could finally ‘unclench’ and ‘move’ his paralysed phantom arm in a mirror-symmetric manner.

(3) Five patients suffered painful ‘clenching spasms’ in their phantom hand.  Following mirror therapy, 4 of 5 patients were finally able to ‘open’ their phantom hand leading to relief from painful spasms.

Mirror therapy may lead to new connections in the brain.  This may include novel and/or reactivation of pre-existing neural pathways between both cerebral hemispheres (Ramachandran & Hirstein, 1998).

Possible Mechanisms

Although there is no shortage of possible explanations, no one really knows why mirror therapy may work better in some patients than in others.

Professor Herta Flor, Neuroscientist, believes that both peripheral input and central changes may be involved in phantom limb pain (Perur, 2014).

Competitive interaction may arise between the two brain hemispheres in stroke patients (and presumably also in amputees).  This can lead to abnormal interhemispheric inhibition (IHI) and weakened motor function.

In stroke patients, mirror therapy and motor training could increase the excitability of the stroke-affected primary motor cortex (M1).  Specifically, mirror visual feedback training could alter the excitability of the transcallosal pathway and restore IHI back to normal.  This could in turn strengthen motor function in the stroke-affected side.

Thus, mirror visual feedback training may help normalise IHI and restore the hemispheric balance between the stroke-affected (or amputation-affected) M1 and the healthy M1 (Avanzino et al, 2014).

Another study reported that mirror visual feedback via a mirror led to improved motor function in 2 patients who had callosal disconnection.  Based on this, they concluded that mirror therapy that leads to improved motor performance does not affect interhemispheric interaction via corpus callosum (Nojima et al, 2013).  Whether this also occurs in amputees is unknown.

Some Questions to Ponder

Could an amputation lead to abnormal IHI and a hemispheric imbalance between the amputation-affected M1 and the healthy M1?

If yes, could this contribute (in part or in full) to ‘painfully frozen limbs’, ‘paralysed phantom limbs’ and phantom limb pain in amputees?

If so, could mirror visual feedback training using mirrors reduce phantom limb pain and other symptoms in some amputees?


Mirror therapy may be a very effective treatment option for amputees with phantom limb pain and other chronic pain sufferers.

Benefits derived from mirror therapy vary from one patient to the next.  According to Professor Christoph Maier, while some amputees are pain-free after only 1 mirror therapy session, others may need to do mirror therapy for the rest of their lives to reduce phantom pain (Liebling, 2010; translated from German).

Who would have thought that a humble mirror could offer relief from excruciating phantom limb pain for some amputees??

Sabina Walker

Blogger, Pain Matters (in WordPress)



Patient Stories

(1) Dobyns, Stephen. Certain San Diegans feel their missing limbs. San Diego Reader (9 July 2008).

(2) Saundra Young. For amputees, an unlikely painkiller: Mirrors. CNN (19 March 2008).


(3) Burgess, Lisa. Mirrors helping amputees fight phantom pain. Stars and Stripes (2/2/2008).


(4) Colapinto, John. Brain Games – The Marco Polo of Neuroscience. The New Yorker (11 May 2009).


Peer-Reviewed Science Papers

(5) Chan BL et al. Mirror therapy for phantom limb pain. N Engl J Med (22 Nov 2007); 357: 2206-2207.

doi: 10.1056/NEJMc071927


(6) Uniformed Services University of the Health Sciences. Phantom Limb Pain May Be Reduced By Simple Mirror Treatment. Science Daily (24 November 2007).


(7) Ramachandran VS & Hirstein W. The perception of phantom limbs. Brain (1998); 121: 1603-30.


(8) Avanzino et al. Training based on mirror visual feedback influences transcallosal communication. Eur J Neurosci (Aug 2014); 40(3): 2581-8.

doi: 10.1111/ejn.12615.

(9) Nojima et al. Mirror visual feedback can induce motor learning in patients with callosal disconnection. Exp Brain Res (May 2013); 227(1): 79-83.

doi: 10.1007/s00221-013-3486-4

(10) Perur, Srinath. The mirror man. mosaic (7 July 2014).


Non-Fiction Book

(11) Ramachandran VS & S Blakeslee. Phantoms in the Brain – Human Nature and the Architecture of the Mind. HarperCollins Publishers (20 May 1999); pages 1 to 352.

ISBN 9781857028959

(12A) Ramachandran VS. The Tell-Tale Brain – A Neuroscientist’s Quest for What Makes Us Human. W.W. Norton & Co (5 April 2012); pages 1 to 357.

ISBN: 9780099537595

(12B) V.S. Ramachandran’s Tales Of The ‘Tell-Tale Brain’. NPR (14/2/2011).


Medical Articles (in German) 

(13) Mit der Spiegeltherapie sind Schmerzen “verlernbar”. Ärzte Zeitung online (22.02.2010).


(14) Liebling, Patricia. Spiegeltherapie hilft gegen Phantomschmerzen. Aachener Zeitung (27 Feb 2010).


(15) Hawlik, Michaela. Leben mit Phantomschmerz. My Handicap (1/2011).


Other Medical Articles (not discussed in this blog post)

(16) Peterzell, David H. Psychophysical investigations into Ramachandran’s mirror visual feedback for phantom limb pain: video-based variants for unilateral and bilateral amputees, and temporal dynamics of paresthesias. 2016 Society for Imaging Science and Technology (Feb 2016).

doi: 10.2352/ISSN.2470-1173.2016.16HVEI-093


(17) Timms, Jason & Carus, Catherine. Mirror therapy for the alleviation of phantom limb pain following amputation: A literature review. International Journal of Therapy and Rehabilitation (March 2015); 22(3): 135-145.


(18) Datta & Dhar. Mirror therapy: An adjunct to conventional pharmacotherapy in phantom limb pain. J Anaesthesia Clin Pharmacol (Oct-Dec 2015); 31(4): 575–578.


(19A) Ol, Ha Sam et al. Mirror therapy for phantom limb and stump pain: a randomized controlled clinical trial in landmine amputees in Cambodia. Scandinavian Journal of Pain (3 July 2018); 18(4): 603-610.

doi: 10.1515/sjpain-2018-0042


(19B) Ol, Ha Sam et al. Mirror therapy: Curing phantom pain in landmine victims. Science Discoveries (26.10.2018).




A Ghost Foot, A Phantom Leg And Frozen Fingers Treated By Mirror Therapy

‘Disability is only a state of mind.’

Bryan Wagner, Amputee 

Feature Image showing mirror therapy sourced from:


For related blog posts, see:





Dear Pain Matters blog readers,

Phantom limb pain (PLP; phantom pain) is a terrible affliction that affects up to 90% of all people who have lost a limb, or part thereof, due to trauma, injury, disease or surgery.

Mirror therapy may be an effective and inexpensive pain treatment option for patients with phantom pain, complex regional pain syndrome (CRPS), pain and lost motor function after stroke, hand immobility and pain caused by spinal stenosis and other conditions.

Mirror therapy is sometimes called mirror visual feedback or graded motor imagery.


Bryan Wagner, Amputee and War Veteran  

Bryan Wagner (23) lost his lower right leg in an improvised explosive device (IED) explosion on 17 December 2007 while serving in Baghdad.  Thereafter, Bryan suffered phantom pain in his missing toes and in the arch of his heel.  The pain included knife-like stabbing pain between his toes and poker-like pain.

Mirror therapy is offered to patients just like Bryan at the Walter Reed Army Medical Centre (WRAMC).  This therapy is done 15 minutes a day, 5 days a week, for 8 consecutive weeks.  If necessary, this cycle is repeated.

During mirror therapy, Bryan stated:

‘It … really feels like you are moving your [missing] foot … It feels like your foot is there …’

If you look very closely at the video below, you will see Bryan’s stump actively participate in all the foot exercises at the same time as the good leg.

It is as if the residual stump is doing all the exercises that the missing foot would be doing, if it were to still exist.  Thus, the stump is acting in lieu of the missing foot!  I don’t know about you but I find this very fascinating!

In other words, the leg stump (that is 100% hidden from Bryan’s view) is moving in complete harmony and unison with the foot’s reflection.  Could it be that optimal results from mirror therapy are possible when this occurs?  (Go to 1:28 minutes.)

Mirror therapy enables the brain to finally ‘feel movement’ again in the (phantom) limb.  Using mirror therapy to restore movement in a missing limb (and in a stump) may be key to reducing phantom limb pain.

Treating Phantom Limb Pain with Mirror Therapy 

Above, a 2-minute YouTube video and narrative by UPIVideo dated 27 July 2009.  NB The narrative may only be available if you open the video in a separate window.

Footless Jo, Amputee and Phantom Pain Sufferer

At age 13, Jo fell off her horse that suddenly tripped while galloping.  As a result of this tragic fall, Jo broke her tibia bone* completely in half.  She subsequently suffered 14 years of pain and more than 10 ankle surgeries.

In 2018 and at age 27, Jo opted for elective amputation of her foot as it was simply not getting any better.

Jo now suffers from phantom pain in her amputated foot.  She calls this her ‘ghost foot’.

Jo’s phantom pain feels as if someone is stabbing her foot, hooking electrical wire up to her toes or peeling the skin off of her ghost foot.

Jo started practising mirror therapy 15 minutes a day for almost a month prior to making her video (below).

During mirror therapy, Jo focuses intently on the reflection of her intact leg (and not on her actual leg).

Quoting Jo,

‘… I am practising these motions with both sides of my body.  

I am trying to mirror these movements and I am visualising that side of my body as if it was fully there.

So as I move my toes, as I move my ankle, I am trying to do so with the side of my body that has been amputated even though it’s not there …

I’m staring into the mirror at the side of my body that has been amputated and visualising that it is still intact …’

While her pain relief lasts for a few seconds only (not hours), Jo is hoping for more pain relief as time goes on.

Although this therapy has not benefited her yet, Jo’s video offers many details about the actual practice of mirror therapy itself, from an amputee’s perspective.


Mirror Therapy: How to Help Phantom Pain 

Above, a 4-minute YouTube video and narrative by Footless Jo dated 8 November 2018. 


Bob McKeefery, a long-time fisherman, has spinal stenosis (i.e. tightening or narrowing) of the spinal canal.  Spinal stenosis can lead to compression and ‘pinching’ of the spinal cord and nerve roots.  This can cause pain, cramping, weakness and numbness as well as abnormal signalling between the brain and the body.

Bob suffered ongoing pain and limited mobility in his right hand following several surgeries over a year ago.

In his words,

‘I could move my right arm, but I couldn’t move my right hand.  So 3 of my digits, the last 3, were like ‘frozen shut’ and 2 were frozen open.’

The good news is that mirror therapy led to immediate benefits including complete pain relief for Bob!  

Quoting Bob,

‘All my pain, a year’s worth of pain, went away in one day!’

After only 1 week of mirror therapy, Bob was finally able to use muscles and do movements that he had long given up on.

Bob said,

‘It was impossible last week for me to do this.  I could not ‘palm up’. …’ 

As Bob continued with mirror therapy, 10 minutes each session, several times a day, he has one goal that keeps him going.

Quoting Bob,

‘[My goal] would be to pick up my grandchildren … because I’m not allowed during this crisis … and they are 1 and 3.’

Thanks to mirror therapy, Bob is now one step closer to his goal!

For more details, watch Mirror Therapy Helps Patients Reduce Pain, Gain Mobility in Limbs, by NJTV News (30 April 2015).


I hope that these stories will inspire others to try mirror therapy for their phantom pain and other painful conditions.  After all, there is no downside in trying mirror therapy.

Sabina Walker

Blogger, Pain Matters (in WordPress)



* Tibia bone – One of 2 bones in the lower leg.


For more information about Footless Jo’s life, see her 7-minute video dated 29 November 2018:



Mirror Therapy For Phantom Limb Pain – ‘What Your Eyes See IS Reality’

‘What Your Eyes See Is Reality’

Erez Avramov, Life Rebuilder

Feature Image of Erez Avramov and the mirror box was sourced as a still frame from the YouTube video dated 8 July 2013 (below).

For related blog posts, see:





Dear Pain Matters blog readers,

Phantom limb pain (PLP; phantom pain) is a terrible affliction that affects up to 90% of all people who have lost a limb, or part thereof, due to trauma, injury, disease or surgery.

Mirror therapy may be an effective and inexpensive pain treatment option for some patients with phantom pain, complex regional pain syndrome (CRPS), pain after stroke and other pain conditions.


Erez’s Traumatic Life Events 

Erez Avramov, Life Rebuilder, survived 3 serious motor vehicle accidents (MVA) and a serious heart attack.  Sounding more like an action thriller story than an enriched life story, Erez is a perfect example of ‘what doesn’t kill you, makes you stronger’.



During his first accident, Erez was involved in a serious head-on crash with a semi-truck after his vehicle hit black ice and spun out of control near Merritt, BC, Canada, in November 2010.  He suffered many injuries including fractures to the sternum, hand and ankle, a crushed rib cage as well as a leg that was broken in 17 different places.

Several years and multiple surgeries later, Erez opted for elective amputation to improve mobility of his MVA-injured right leg below the knee (ADV Pulse, 2014)

Erez holds the honour of being the first amputee ever to enter the Dakar Rally race in South America.  Sadly, he had his second near-fatal accident when he crashed his motorbike during one of these desert races.

More recently, Erez had another vehicle accident in December 2017 that was followed by a serious heart attack just one (1) month later.

Being optimistic by nature, Erez always tries to gain valuable insight even from the worst moments in his life.  For his inspirational views, please visit his website:


Erez’s Mirror Therapy for Phantom Limb Pain  

Following his elective lower right leg amputation, Erez suffered phantom pain.

In his words,

‘… the results and the process [of mirror therapy are] just amazing.’

Erez used a custom-made 3-sided mirror box that included a white-framed mirror.  Hinged on both sides, the mirror box can be unfolded and assembled like a ‘triangular tunnel’.  A plain mirror may also be used.

Erez’s good leg was placed right next to the mirror while his amputated right leg remained well hidden inside this triangular tunnel.

As Erez moved his toes very slowly, he tried to imagine moving the same muscles in his phantom toes at the same time.

Given that he spoke about mirror therapy with such amazing clarity, I will quote Erez from here on (see his YouTube, below),

‘… This is the important part … you move your toes and you try with your mind to move … your missing toes – but when you look at them in the mirror, it’s as if they are there … and you feel your muscles in your residual limb …  Move those toes as if they are there.  

Then I will start to do some rotational work , and I will move both legs in the same direction as if everything is there.  

Because what happens is:  Your brain sees this leg and your foot.  It thinks it is there.

This is the most bizarre thing there is.  It is as if you still have it … You  really have to be open-minded and to accept the fact that what your eyes see is reality … It’s almost like you bypass this reasoning side of your brain …

I will move my muscles.  I will move my residual limb as if I have an intact full foot …

The results were amazing … [inserted: my painful ‘tiger-clawed’ phantom toes were] released, so the pain is gone …

… the protocol is 4 weeks of 10 minutes every day.  You do this for 4 weeks …

… You cover your residual limb.  You use … a … magazine cover, or whatever, … to hide your good foot so you don’t see it, and all you want to see is your reflection of your foot, as if you still have [a] missing limb …’ 

Watch Erez Avramov’s helpful video, here:

‘Mirror Therapy – Personal Success Story’

An 8-minute YouTube dated 8 July 2013


Thank you very, very much, Erez, for sharing your powerful story about your personal experience with mirror therapy!

I am sure that your story will inspire others to try mirror therapy for their phantom pain.

Sabina Walker

Blogger, Pain Matters (in WordPress)



(1) http://erezavramov.com

(2) Amputee Pursues Lifelong Dream to Race the Dakar Rally. ADV Pulse (27/10/14).






Mirror, Mirror, Short Or Tall, Which One Has No Pain At All?

Title adapted from:

Mirror, mirror on the wall, who is the fairest of them all?

Feature Image sourced from:


For related blog posts, see:





Dear Pain Matters blog readers,

Up to 90% of all amputees suffer from phantom limb pain (PLP), or more simply, phantom pain.

Mirror therapy is an inexpensive pain treatment option for some patients with phantom pain, complex regional pain syndrome (CRPS), pain after stroke and other painful conditions.

Stephen Sumner (aka Mirror Man), an amputee and humanitarian from Vancouver, Canada, was so impressed with the pain-relieving effects of mirror therapy on his phantom pain that he set up his mission called ‘Me and My Mirror’.


Reality is merely an illusion, albeit a very persistent one.

Albert Einstein

Stephen’s Story, Before Mirror Therapy

Stephen endured a left above-knee amputation after a truck crashed into his scooter in a hit-and-run accident that left him for dead on a quiet country road near Siena, Italy, one balmy evening in 2004.

Using his words, Stephen ‘suffered terribly … suicidally’ from severe PLP for 4 – 5 years thereafter.  He used to endure ongoing electrifying shocks that shot up his missing left leg and throughout his body.

Quoting Stephen, it was like having ‘lightning bolts through my foot’ in a leg that no longer existed.  His entire body would jolt and spasm uncontrollably, as if he was ‘being spiked with a cattle prod day and night’.  Stephen would be reduced to screaming and tears with no sleep at all during these severely painful bouts.

Stephen added, ‘I could have killed myself.’

Stephen’s phantom toes would be ‘stuck’ in an excruciatingly painful and clenched position.  The pain ‘was like a vice over the back of my heel.  It was like it was being crushed.’  Stephen’s phantom pain felt like ‘crippling electric pulses’ … ‘burning and crushing, but the worst is the itching’.

Stephen stated that his phantom pain was ‘… not in the head, it’s in the limb.’

Stephen’s Story, After Mirror Therapy

Then one day, Stephen read about mirror therapy on-line.  The first time he placed a mirror against his left thigh and looked at the reflection of his right leg (where the left leg used to be), he felt immediate relief.  Five (5) minutes later, his pain was gone.  Stephen did mirror therapy twice daily for 10 minutes at a time.  Finally, after 5 weeks, his phantom pain disappeared for good. 

Quoting Stephen, mirror therapist:

‘… within … 3 and 5 weeks, the pain … disappeared … my phantom pain had gone away, almost magically …’ 

Stephen continued,

‘… 10 minutes per session, 2 sessions per day, 5 weeks, and you’re done for life … If I get some kind of a flare-up, I just whip out the mirror, and I’m good again …’

(Go to the following 10-minute video called The Me & My Mirror Back Story; 2:30 minutes).

Stephen offers mirror therapy to amputees with phantom pain in 3rd world countries including Cambodia, Laos, Vietnam, Sri Lanka, Burma, Myanmar, Vietnam, southern part of India, Lebanon, Ethiopia, Syria, Egypt, Tunisia, Algeria and the western Sahara region.

Stephen often treats amputees with PLP due to traumatically torn or mutilated limbs resulting from war, landmine blasts, unexploded ordnances (cluster bombs, cluster munitions) and road accidents.  Stephen also treats patients who lost their limbs due to severe diabetes and other diseases.

Stephen collaborates with medical experts in the local hospitals, trauma centres, physical rehabilitation centres and prosthetic clinics.  Recently, he was at the ‘Jaffna Teaching Hospital’ with Physical Rehabilitation Therapists and Orthopedic Surgeon.  He also teaches locals how to make therapeutic mirrors for pain relief.

Stephen uses this simple mantra for mirror therapy:






Source: http://meandmymirror.org

In Stephen’s words,

‘… You feel immediate relief, but you have to carry on for 4 or 5 weeks.  So, my mantra is:

  • 2 sessions a day 
  • 10 minutes per session
  • 5 weeks.’

(Global News, 2016)


Source: http://meandmymirror.org

Stephen uses acrylic mirrors due to their cost-effectiveness, safety, lightweight nature and transportability (i.e. on the back of his beloved bicycle).


Source: http://meandmymirror.org


According to Stephen, it is often difficult for amputees in Cambodia and other 3rd world countries to open up about their phantom pain.  Many amputees with phantom pain are ashamed.  They would rather suffer in silence than risk being labelled as ‘outright crazy’ or ‘insane’ for ‘complaining’ about pain in a limb that does not even exist.

Also, the fact that many amputees here are Buddhists raises the topic of karma including what the amputees ‘must have done in a previous life to deserve this fate’.

When Stephen is seen riding around on a bicycle with his prosthesis clearly visible to all, the locals are more likely to empathise and connect with him.  When Stephen tells them that he used to suffer from phantom pain, they finally open up about their own phantom pain.



Source: http://meandmymirror.org


A Cambodian Amputee Named Pov Sopheak 

Pov Sopheak (50), a former soldier and security guard in Cambodia, is also an amputee with phantom pain.  He traumatically lost his left leg in a landmine explosion in 1990.  Pov’s severe phantom pain including sharp pains in his phantom big toe and little toe affected the quality of his life including sleep for 2 decades.

In Pov’s words,

‘[It] feels like my leg is shaking.’   

Pov’s life finally turned a corner after meeting Stephen.

With Stephen’s guidance, Pov used the mirror to ‘trick’ his brain into thinking that his left leg was not missing after all, but rather, still very intact.  While moving his right leg including wiggling his toe and flexing his foot in front of the mirror, Pov was able to ‘fool’ his brain into thinking that the reflection of his good leg was that of his missing left leg.

This simple yet elegant treatment helped to relax Pov immensely.  Furthermore, Pov’s brain was able to imagine and ‘perceive movement’ in his missing left leg again, after decades of ‘immobility’ and ‘non-use’.  Mirror therapy was able to jump-start brain circuitry pertaining to his left leg.  For Pov (and many others just like him), this was a prerequisite for phantom pain relief.

Quoting Pov,

 ‘It’s a new sensation. It’s strange but in a good way … I see my leg in the mirror and I feel happy, like my mind is at ease.’

Pov made a commitment to mirror therapy for 4 – 5 weeks in the hope that his phantom pain would lessen with time.

Additional Thoughts

In the absence of incoming signals from both legs (and/or in the presence of abnormal signals coming in from the stump itself), a brain may become chronically stressed.  This often leads to phantom pain.  

On the other hand, many amputees with phantom pain instantly feel better during mirror therapy.  The reflection of the intact limb in the mirror helps to ‘convince’ their brain that it is finally perceiving two (2) normal limbs.  

Importantly, many amputees are finally able to ‘move’ their phantom limb for the first time in years, and perhaps decades, during mirror therapy.  This can lead to a state of calm and relaxation, together with immediate pain relief.  

In Stephen’s words,

‘Looking in the mirror, the brain suddenly enables you to move your phantom foot and do everything the real foot is doing.’

‘The brain just wants to be tricked. It’s dying for release’ (Fitzpatrick, 2012).




Photo sourced from: http://meandmymirror.org

If you would like to support Stephen’s important mission to deliver mirror therapy and a therapeutic mirror to PLP amputees in 3rd world countries, please go here: 


More details are available on Stephen’s website and in his book called Phantom Pain: A Memoire: It’s All in Your Head.



You can also follow Stephen on social media including Twitter and Facebook.

Biking Laos – Mirror Man Cycling Laos 

2 Times, 10 Minutes, 4 Weeks (21/1/2013)


Several questions to ponder over include:

  • What % of amputees are finally pain-free after 4 – 5 weeks of mirror therapy?
  • What % of amputees remain pain-free 6 – 12 months after mirror therapy?
  • If the benefits are not lasting in some amputees, can mirror therapy be done repeatedly to relieve phantom pain?
  • Are left-sided amputees more likely to benefit from mirror therapy than right-sided amputees (or vice versa)? If so, why?  If not, why not?
  • Is the corpus callosum in the brain involved?


Stephen’s easy-going, can-do attitude as well as his passion and commitment to treat amputees with PLP via mirror therapy have made him a welcome hero in many 3rd world countries.

In his friend’s words,

‘He’s not your regular officious [non-government organisation] guy.  He rides up on his bicycle with a smile on his face and a bunch of mirrors.’

In my view, Stephen is one amazing guy with one big heart!

… And I am not the only one who thinks this!

A fiction movie called ‘ Phantom Pain’ (in German, ‘Phantomschmerz’), released in 2009, was completely inspired by Stephen’s early experiences as an amputee.


Sabina Walker

Blogger, Pain Matters (in WordPress)



Your perception IS your reality.




(1A) Sumner, Stephen. Me and My Mirror.



(1B) Fitzpatrick, Michelle. Mirrors ease Cambodian amputees’ phantom pain. The China Post and AFP (28/2/2012).


(1C) Perur, Srinath. The mirror man. mosaic (7 July 2014).


(1D) Otis, Daniel. Meet the ‘Mirror Man’ who’s on a mission to help fellow amputees. CTV News (25 December 2018).


(1E) Ross, Amy. Mirror Medicine: A Cure for Phantom Limb Pain? Pacific Rim Magazine.


(1F) Mullen, Dene. The man with the mirror. Southeast Asia Globe (12 July 2013).


(1G) Man in the Mirror. Asia Life (2/2/2012).


(1H) Other articles:



(2A) Me and My Mirror 2018 (6-minute YouTube)


(2B) Mirror-therapy and how it helps amputees. Global News (12 January 2016) (3-minute video)


(2C) Mirror therapy hoping to help amputees with pain. Global News (30 Oct 2014 (a 6-minute video).


(2D) Other videos:


Film (Fiction, in German; Inspired by Stephen Sumner’s Experience)

(3) Emcke, Matthias. Phantom Pain (Original Title: Phantomschmerz) (2009).




This is the story of my exploration on matters of chronic pain.