The "FaBo Mirror" therapy protocol in the neuropsychological correction of phantom limb pain: theoretical rationale and description of the method

Objective: to introduce and provide a theoretical rationale for the FaBo Mirror, a standardized clinical–psychological and neuropsychological mirror therapy protocol developed for the correction of phantom limb pain (PLP), and to describe its construction principles, procedure, and efficacy assessment system.
Materials and Methods: a theoretical–methodological analysis of PLP was combined with a structured description of the protocol. The framework integrates Anokhin's theory of functional systems with the neuromatrix concept, cortical reorganization, pain memory, and the medical psychology of bodily experience. Equipment, conditions, step–by–step procedures for upper– and lower–limb amputations, course organization (five 50–minute sessions twice weekly), specialist requirements, indications and limitations are presented.
Results: the session is composed of sensory, motor, and goal–directed components organized into a fixed sequence. The core motor task – the serial fist–edge–palm sequence performed under mirror visual feedback – is grounded in evidence of reproducible bilateral activation of the motor cortex in healthy subjects. A three–level assessment system is proposed: the Numeric Rating Scale, the Well–being–Activity–Mood questionnaire, and the EQ–5D–5L. Observations from an ongoing clinical pilot application are interpreted as a limited indication of the protocol's feasibility.
Conclusions: the FaBo Mirror is a reproducible, theoretically grounded neuropsychological technology for PLP correction; its clinical efficacy requires confirmation in randomized controlled trials with follow–up

1. Korabel'nikov D.I., Tkachenko E.V., Magomedaliev M.O. Phantom pain: epidemiology and etiopathogenesis. Epilepsiya i paroksizmal'nye sostoyaniya (Epilepsy and paroxysmal states). 2025; 17(1):82–93. (in Russian). doi: 10.17749/2077-8333/epi.par.con.2025.222

2. Rosca A.C., Baciu C.C., Burtaverde V., Mateizer A. Psychological consequences in patients with amputation of a limb. An interpretative-phenomenological analysis. Frontiers in Psychology. 2021; 12:537493. doi:10.3389/fpsyg.2021.537493

3. Sayko A.V. Current state of the problem of phantom pain. Mezhdunarodnyy nevrologicheskiy zhurnal (International Neurological Journal). 2018; (4):84–89. (in Russian). doi: 10.22141/2224-0713.4.98.2018.139430

4. Nikishina V.B., Bobyntsev I.I., Petrash E.A., Minyakhina K.A. Descriptors of interoceptive sensations in phantom pain syndrome in people with lower limb amputation. Kurskij nauchno-prakticheskij vestnik «Chelovek i ego zdorov'e» (Kursk Scientific and Practical Bulletin "Man and His Health"). 2015; (3):133–138

5. Federal'nye klinicheskie rekomendacii po predotvrashcheniyu fantomnogo bolevogo sindroma pri amputacii konechnosti. Moscow, Ministerstvo zdravoohraneniya Rossijskoj Federacii, 2014. (in Russian).

6. Ramachandran V.S., Rogers-Ramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proceedings of the Royal Society B: Biological Sciences. 1996; 263(1369):377–386. doi:10.1098/rspb.1996.0058

7. Barbin J., Seetha V., Casillas J.M., Paysant J., André J.M. The effects of mirror therapy on pain and motor control of phantom limb in amputees: a systematic review. Annals of Physical and Rehabilitation Medicine. 2016; 59(4):270–275. doi:10.1016/j.rehab.2016.03.002

8. Rothgangel A.S., Braun S.M., Beurskens A.J., Seitz R.J., Wade D.T. The clinical aspects of mirror therapy in rehabilitation: a systematic review of the literature. International Journal of Rehabilitation Research. 2011; 34(1):1–13. doi:10.1097/MRR.0b013e328343459c

9. Weeks S.R., Anderson-Barnes V.C., Tsao J.W. Phantom limb pain: theories and therapies. The Neurologist. 2010; 16(5):277–286. doi:10.1097/NRL.0b013e3181ec95e8

10. Hoffmann T.C., Glasziou P.P., Boutron I., Milne R., Perera R., Moher D., Altman D.G., Barbour V., Macdonald H., Johnston M., Lamb S.E., Dixon-Woods M., McCulloch P., Wyatt J.C., Chan A.W., Michie S. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014; 348:g1687. doi:10.1136/bmj.g1687

11. Nikishina V.B., Shagina E.D., Yunina-Pakulova N.Yu., Petrash E.A. Metodicheskie rekomendatsii po sposobu korrektsii fantomnykh boley metodom zerkal'noy terapii «Zerkalo FaBo» [Methodological guidelines for the correction of phantom limb pain by means of the FaBo mirror therapy]. Moscow, 2024. 60 p. ISBN 978-5-6052703-2-4. (in Russian).

12. Shagina E.D., Nikishina V.B., Zapesotskaya I.V. Neuropathogenesis of phantom pain syndrome: overview of foreign research. Nacional'nyj psihologicheskij zhurnal (National Psychological Journal). 2025; 20(2), 24–36. https://doi.org/10.11621/npj.2025.0202

13. Collins K.L., Russell H.G., Schumacher P.J., Robinson-Freeman K.E., O'Conor E.C., Gibney K.D., Yambem O., Dykes R.W., Waters R.S., Tsao J.W. A review of current theories and treatments for phantom limb pain. Journal of Clinical Investigation. 2018; 128(6):2168–2176. doi:10.1172/JCI94003

14. Anokhin P.K. Ocherki po fiziologii funktsional'nykh sistem. Moscow, Meditsina, 1975. (in Russian).

15. Melzack R. Phantom limbs and the neuromatrix. Trends in Neurosciences. 1990; 13(3):88–92. doi:10.1016/0166-2236(90)90179-E

16. Flor H., Nikolajsen L., Jensen T.S. Phantom limb pain: a case of maladaptive CNS plasticity? Nature Reviews Neuroscience. 2006; 7(11):873–881. doi:10.1038/nrn1991

17. Woodhouse A. Phantom limb sensation. Clinical and Experimental Pharmacology and Physiology. 2005; 32(1–2):132–134. doi:10.1111/j.1440-1681.2005.04142.x

18. Kaur A., Guan Y. Phantom limb pain: a literature review. Chinese Journal of Traumatology. 2018; 21(6):366–368. doi:10.1016/j.cjtee.2018.04.006

19. MacLachlan M., McDonald D., Waloch J. Mirror treatment of lower limb phantom pain: a case study. Disability and Rehabilitation. 2004; 26(14–15):901–904. doi:10.1080/09638280410001704584

20. Doskin V.A., Lavrent'eva N.A., Miroshnikov M.P., Sharay V.B. A test of differentiated self-assessment of functional state. Voprosy psihologii (Voprosy psikhologii). 1973; (6):141–145. (in Russian).

21. Dworkin R.H., Turk D.C., Wyrwich K.W., Beaton D., Cleeland C.S., Farrar J.T., Haythornthwaite J.A., Jensen M.P., Kerns R.D., Ader D.N., Brandenburg N., Burke L.B., Cella D., Chandler J., Cowan P., Dimitrova R., Dionne R., Hertz S., Jadad A.R., Katz N.P., Kramlinger K., Martin S.A., McDermott M.P., McGrath P.J., Narayana A., Quessy S., Robinson J.P., Schein J., Sharma S., Sheth T., Tarragona-Salgado J., Turk N., Witter J., Zavisic S. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. The Journal of Pain. 2008; 9(2):105–121. doi:10.1016/j.jpain.2007.09.005

22. Mokienko O.A., Bobrov P.D., Soloveva A.A., Isaev M.R., Kerechanin Ya.V., Ratnikova V.Yu., Kataitsev V.A., Shagina E.D., Nikishina V.B. Neurophysiological markers of the illusion caused by the mirror visual feedback. Vestnik RGMU (Bulletin of RSMU). 2025; (5):82–90. doi: 10.24075/brsmu.2025.052

23. Thieme H., Morkisch N., Mehrholz J., Pohl M., Behrens J., Borgetto B., Dohle C. Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews. 2018; (7):CD008449. doi:10.1002/14651858.CD008449.pub3

24. Eldridge S.M., Chan C.L., Campbell M.J., Bond C.M., Hopewell S., Thabane L., Lancaster G.A. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ. 2016; 355:i5239. doi:10.1136/bmj.i5239

25. Oldfield R.C. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia. 1971; 9(1):97–113. doi:10.1016/0028-3932(71)90067-4