Effects of Combined and Alone Transcranial Motor Cortex Stimulation and Mirror Therapy in Phantom Limb Pain: A Randomized Factorial Trial.

Only traumatic lower-limb amputees were included, so the results do not apply to upper-limb, congenital, oncological, or nontraumatic amputees. The number randomized was smaller than the target sample, and some participants dropped out, which reduces confidence in the precision of the findings. Time since amputation was imbalanced in one group, which may have affected the comparison. Mirror therapy could not be fully blinded, so expectations and attention may have influenced the control condition. The covered-mirror control may have had real therapeutic effects, so the trial cannot separate specific mirror feedback from movement, imagery, attention, or placebo. TMS was measured in the hand area rather than the leg area. This does not directly assess the cortical representation of the amputated limb. Predictor analyses were post hoc and should be treated as hypothesis-generating.

The authors declared no potential conflicts of interest with respect to the research, authorship, or publication.

Do not conclude that adding mirror therapy to tDCS gives extra pain relief. The interaction was not significant, and active mirror therapy did not beat a covered-mirror control.