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Letters to the Editor Issue 236

by Letters(more info)

listed in letters to the editor, originally published in issue 236 - February 2017

Tribute Obituary Christine Johnston

16th May 1940 - 27 Sept 2016

Christine Johnston

Christine Johnston passed away peacefully on 27 Sept 2016. She had been a Reiki Master Practitioner and Teacher and had been practising and teaching Reiki for many years. She studied with various different Masters, both Western and Eastern styles. She was a member of the UK Reiki Federation Management Committee for several years. She also trained in Kinesiology, Counselling and treated patients with a Scenar machine. She practised at her home in Suffolk and in NW London. Christine also took small groups to Ladakh to visit the Buddhist monasteries and to Kerala to see the Hindu festivals.

For many years Christine was an advocate for access to natural treatment approaches to cancer; her business Naturelle previously supplied high quality apricot seeds from the Himalayas.

Christine had many sides to her delightful personality as shared by family relatives:

  • Christine the adventurer:  In her late teens, having acquired some secretarial skills, she and a friend went off to New York, where, at the time, an English secretary was a well-paid status symbol.  They quickly made enough money to buy a VW minibus and used it to tour America.  When funds ran short, they would stop and get well-paid temporary employment.  From there she went to France and lived in Paris for the best part of a year.  Her love of travel continued over the years with frequent visits to India, Africa, France and Portugal and until 2014 she was taking groups of tourists to enjoy the Buddhist monasteries of the Himalayan foothills – especially Ladakh;
  • Christine the motorist:  When in Paris, she owned a Mini and her great pleasure was in driving round and round the Arc de Triomphe playing dodgems with the French rush-hour traffic.  She had a magnificent disregard for speed limits and indeed, for a number of driving conventions, her early driving experience having been in go-karting round her father’s go-kart track at his Hertfordshire farm;
  • Christine the outdoor girl:  The farm also had horses and a groom who taught her to become an excellent horsewoman.  She played good tennis and was a fine and brave skier, taking on the black runs, despite the demands and dangers they presented.  However, it has to be said that she hated golf;
  • Christine the hostess;  There was a steady flow of visitors – friends, neighbours, friends of the children, parents of friends of the children, etc etc – when she was raising the family in her London home.  From impromptu meals to dinner parties to New Year’s eve parties, to cooking for the family, Christine was constantly providing hospitality of the highest order; all made possible, I suppose, by her endless supply of energy;
  • Christine the elephant fanatic:  All her life Christine had a passion for elephants to which her house bears witness;  there they existed in every conceivable medium, though she preferred the real thing and spent much time in Africa and India supporting elephant conservation programmes;
  • Christine the family girl:  She held firm beliefs about the importance of a united family life, raising her own three children and helping with the seven grandchildren who showed up over the years;  leave a baby with her for a week and it would come back happy and potty-trained.  She was the grandmother-from-heaven and adored by them all.

I was profoundly sad when I heard she was ill in spring 2016 and passed away in the autumn of 2016. I will always remember the numerous discussions and conversations we had about the venality of the outdated Cancer Act of 1939, as she eloquently wrote in her Letter to the Editor in PH Online Issue 220; extracted again here:

“Many people are unaware that this outdated Cancer Act Chapter 13, section 4 exists. It states that it is illegal for anyone to advertise or practise any cancer treatment apart from surgery, chemotherapy and radiation. It is also illegal to make any claims about cures or potential cures using complementary / alternative or integrated health methods.[1]

“There are a range of complementary therapies which greatly help the prevention of cancer cells from forming and which also can give relief to those already suffering from cancer:  meditation, visualizations, Reiki and other relaxing hands on therapies, and not forgetting diet and lifestyle. All these therapies can be used alongside the allopathic [conventional] treatments OR as an alternative, but we are legally not allowed to make people aware of this and we certainly cannot make any claims.[2-4]

“There is a lot of very important scientific research going on and this is very valuable, for example: Dr Dylan Edwards from the Norwich Research Park studies the inherited genetics of cancer.[5] An estimated £600 million is spent on cancer research every year[6-7] and this is mostly spent on searching for drugs that will kill the cancer cells, whereas we should surely be looking for ways of preventing cancer cells from forming in the first instance..

“Why are we not researching and educating people in ways to PREVENT cancer?

“Many individuals  have benefitted from taking vitamin B17 or Laetrile, Essiac tea, mistletoe injections and even coffee enemas; in fact some people have actually destroyed the cancer cells completely using these alternative methods, sometimes in conjunction with various therapies.[3,8]

“Recently the Chairman of the Parliamentary Group for Integrated Healthcare, MP David Tredinnick, who has been a long-time supporter of complementary therapies, participated in the Ministry of Health Committee meeting. 

“But we still have this outdated Cancer Act.  When is it going to be brought up to date?”

References supplied on the Page. 



Dietary Magnesium Associated with Reduced Risk of Heart Disease, Stroke and Type-2 Diabetes

A diet rich in magnesium may reduce the risk of diseases including coronary heart disease, stroke and type-2 diabetes according to a new meta-analysis published in the open access journal BMC Medicine. This analysis of the evidence on dietary magnesium and health outcomes is the largest to date, involving data from more than one million people across nine countries.[1]

The researchers, from Zhejiang University and Zhengzhou University in China, found that people in the highest category of dietary magnesium consumption had a 10% lower risk of coronary heart disease, 12% lower risk of stroke and a 26% lower risk of type-2 diabetes compared to those in the lowest category. Their results also indicate that an extra 100mg per day of dietary magnesium could also reduce risk of stroke by 7% and type-2 diabetes by 19%.  

Dr Fudi Wang, lead author from the School of Public Health at Zhejiang University, said: “Low levels of magnesium in the body have been associated with a range of diseases but no conclusive evidence has been put forward on the link between dietary magnesium and health risks. Our meta-analysis provides the most up-to-date evidence supporting a link between the role of magnesium in food and reducing the risk of disease.”

Dr Wang added: “The current health guidelines recommend a magnesium intake of around 300mg per day for men and 270mg per day for women. Despite this, magnesium deficiency is relatively common, affecting between 2.5% and 15% of the general population. Our findings will be important for informing the public and policy makers on dietary guidelines to reduce magnesium deficiency related health risks.”

Magnesium is vital for human health and normal biological functions including glucose metabolism, protein production and synthesis of nucleic acids such as DNA. Diet is the main source of magnesium as the element can be found in foods such as spices, nuts, beans, cocoa, whole grains and green leafy vegetables. 

In this analysis, data from 40 epidemiological studies covering a period from 1999 to 2016 were used to investigate associations between dietary magnesium and various diseases. In all the studies, levels of dietary magnesium were determined using a self-reported food frequency questionnaire or a 24-hour dietary recall. As the levels of magnesium used to define categories varied widely between the studies, the researchers performed a dose-response analysis for the effect of each 100mg per day increase of dietary magnesium.

This meta-analysis involves observational studies meaning that it is not possible to rule out the effect of other biological or lifestyle factors influencing the results. It is also not possible to determine if magnesium is directly responsible for reducing disease risk. However, the large size of this analysis provides robust data that were stable when adjusting for gender and study location. The authors state that their findings reinforce the notion that increased consumption of magnesium rich foods could be beneficial for overall health.


1. Fudi Wang et al. Dietary magnesium intake and risk of cardiovascular disease, type 2 diabetes, and allcause mortality: A dose-response meta-analysis of prospective cohort studies. BMC Medicine 2016. DOI: 10.1186/s12916-016-0742-z  

Source: Matthew Lam, BioMed Central

Tel: +44 (0)20 3192 2722

Mob: +44 (0)75 4079 9187

About BMC Medicine

BMC Medicine is an open access, open peer-reviewed general medical journal publishing outstanding and influential research in all areas of clinical practice, translational medicine, public health, policy, and general topics of interest to the biomedical research community. As the flagship medical journal of the BMC series, we also publish stimulating debates and reviews as well as unique forum articles and concise tutorials. 

About BioMed Central

BioMed Central is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Nature, a major new force in scientific, scholarly, professional and educational publishing, created in May 2015 through the combination of Nature Publishing Group, Palgrave Macmillan, Macmillan Education and Springer Science+Business Media.



Controversial Vaginal Mesh and Graft No More Effective than Standard Repair for Female Prolapse

Two controversial methods of surgical repair of prolapse in women have been found to be no more effective than the existing standard repair technique, up to two years after surgery.

Widespread concerns about the use of mesh and graft in prolapse surgery have been raised in public, with some patients reporting serious complications. Consequently, the use of mesh was banned in Scotland (with the exception of clinical trials) in June 2014 until further evidence was found regarding its suitability.

Researchers at the University of Aberdeen led a national collaborative research project comparing the outcome of pelvic organ prolapse repairs reinforced by either non-absorbable synthetic mesh or biological grafts against standard native tissue repairs in 1348 women.

They found the mesh, inserted through the vagina, resulted in a number of complications but did not offer any clear benefits, concluding that its use for these procedures could be considered an “unnecessary risk”, until further research was conducted.

The study was the largest randomised trial of the use of mesh or graft in transvaginal prolapse surgery and the results have been published today in the world’s leading medical journal The Lancet.[1]

Pelvic organ prolapse occurs when one or more of the pelvic organs bulges into the vagina, which can affect around 40% of women. It is associated with childbirth and increasing age.  Symptoms can include vaginal discomfort and urinary, bowel and sexual problems.

Up to one in 20 women with prolapse symptoms will need surgery to correct it and of those women, around three in ten will eventually need more prolapse surgery.  On average, this happens about 12 years after the first operation.

Previous studies suggested non-absorbable mesh was more successful than standard native tissue to repair prolapse but there was not enough reliable evidence about other symptoms or quality of life.  Studies comparing biological grafts with standard repair were inconclusive.  There was not enough information about adverse effects to enable women and their doctors to judge which operation was safest.

The PROSPECT study was funded by an NHS research grant from the National Institute for Health Research (NIHR) Health Technology Assessment programme in 2007 to find that necessary reliable evidence.  It consisted of two parallel randomized controlled trials, involving 1348 women having surgery for pelvic organ prolapse. The study was carried out in women attending 35 different hospitals across the UK, in conjunction with over 100 doctors and researchers between January 2010 and August 2013. 

Participating women used a self-assessment questionnaire (Pelvic Organ Prolapse Symptom Score or POP-SS) to record their prolapse symptoms.  Other symptoms and side-effects were also measured.

The Lancet paper published today reports the results for women having their first vaginal prolapse operation.

The results revealed that there was no significant clinical or statistical difference between those who had the mesh or graft surgery, compared to the standard native tissue repair, at one or two years after the surgery.

The study also revealed that more than one in ten women who had synthetic (non-absorbable) mesh had a mesh complication - though most were asymptomatic.  However, there were no similar risks with biological grafts.

Researchers stressed that this study has only recorded the outcomes during the first two years after the operation. Because half the prolapse surgeries that fail do so within 12 years, they are following up the same women at regular intervals up to at least 12 years.  This is vital to determine whether mesh or graft repairs might prove more durable in the longer term.

The researchers concluded that using mesh, inserted through the vagina, could pose an unnecessary risk because some women who had been treated with mesh required extra surgical procedures in theatre for mesh complications. They suggested that in the future, synthetic mesh should only be used in clinical trials aimed at identifying better materials, improving insertion techniques or for use in a defined category of high risk women.

Professor Cathryn Glazener, who led the study said: “This study showed in the first two years after surgery, there was no benefit to women having their first prolapse repair from the use of transvaginal synthetic mesh or biological graft to reinforce a standard anterior or posterior repair, either in terms of prolapse symptoms or in short term anatomical cure.

“This contrasts with the conclusions of the most recent Cochrane review which reported that fewer women were aware of prolapse symptoms with synthetic mesh and fewer had anatomical recurrence, compared with women who did not have mesh.

“Our findings provide robust evidence on which to base counselling for surgical decision making. However, these findings are confined to the first two years after surgery and only to women having their first repair. Longer-term follow up is required to truly assess any potential benefits or adverse effects of transvaginal mesh or graft.

“Because mesh did result in a number of complications, with no clear benefits, we conclude its use for these procedures could be considered an unnecessary risk.  Therefore we consider that mesh should only be used in the future in high quality clinical trials aimed at improving the results of vaginal prolapse surgery.”

The study was carried out in collaboration with Glasgow Caledonian University, NHS Grampian, Plymouth Hospitals NHS Trust, Central Manchester University Hospitals and NHS Foundation Trust.


1. Glazener Cathryn MA. Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT). The Lancet Vol 388 (10063) 20 December 2016. DOI:

Research Methodology

PROSPECT (PROlapseSurgery: Pragmatic Evaluation and randomised ControlledTrials) took place between January 2010 and August 2013. 1352 women were randomly allocated to treatment, of whom 1348 were included in the analysis. 865 women were assigned to the mesh trial (430 assigned to standard repair alone, 435 to mesh augmentation) and 735 were assigned to the graft trial (367 assigned to standard repair alone, 368 to graft augmentation) *

*Because the analyses were carried out separately for each trial (Mesh trial (standard repair v synthetic mesh) and Graft trial (standard repair v biological graft)) some women (252 women) in the standard repair arm from Stratum A were included in the standard repair arm of both the Mesh trial and the Graft trial.


1. The National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme funds research about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest NIHR programme and publishes the results of its research in the Health Technology Assessment journal, with over 700 issues published to date. The journal’s 2014 Impact Factor (5.027) ranked it two out of 85 publications in the Health Care Sciences and Services category. All issues are available for download, free of charge, from the website. The HTA Programme is funded by the NIHR, with contributions from the CSO in Scotland, NISCHR in Wales, and the HSC R&D Division, Public Health Agency in Northern Ireland.

2. The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website

Authors’ Note

This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Source and Contact Details

"University of Aberdeen"

Contact: Euan Wemyss; Tel: 01224 272960



Genetic Memory of Starvation May Curtail Lifespan of Men – Tel Aviv University study finds famine may have a lasting impact on male descendants of its victim

 New Tel Aviv University research suggests that periods of fasting or starvation may significantly shorten the lifespans of both children and their male descendants. 

The study focused on survivors of a mass famine that took place in the early 1920s in several rural regions of Russia. It was led by Prof. Eugene Kobyliansky of TAU's Sackler School of Medicine and conducted by doctoral student Dmitry Torchinsky of TAU's Raymond and Beverly Sackler Faculty of Exact Sciences, in collaboration with Dr Leonid Kalichman of Ben-Gurion University's Department of Physical Therapy and Prof. David Karasik of Bar Ilan University's Faculty of Medicine in the Galilee. Its conclusions were published in The American Journal of Clinical Nutrition.

"A variety of experimental and epidemiological studies have tried to propose that intermittent or periodic fasting, like caloric restriction, may slow the aging process and extend lifespans," said Prof. Kobyliansky. "But there is also evidence demonstrating that even moderate caloric restriction may not extend but, on the contrary, can shorten the human lifespan."

A Lesson from Russia

Past research suggests a strong correlation between telomere dynamics and the processes that determine human aging and lifespan. Telomeres, compound structures at the end of each chromosome that protects the end of the chromosome from deterioration, are the genetic key to longevity. They shorten with every chromosome replication cycle.

The team evaluated telomere lengths in a population–based sample comprised of survivors of the mass famine of the early 1920s and in the survivors' descendants, who originated from Chuvashia, a rural area in the mid-Volga region of Russia. In Chuvashia, the proportion of starving inhabitants reached 90% in late March 1922, and mortality among starving peasants reached between 30-50%. The situation only began to improve in April 1923. By the end of that year, the mass famine in Chuvashia was considered over.

The researchers arrived at three major discoveries: (1) There were shorter leukocyte telomeres in men born after 1923 after the mass famine ended than in men born before 1922; (2) there was a stable inheritance of shorter telomeres by men born in ensuing generations; and (3) there was an absence of any correlation between shorter telomeres and women born before or after the event.

"This study, while demonstrating that starvation has the potential to shorten telomere length, raises several questions," said Prof. Kobyliansky. "Does starvation exert a stronger effect on telomere length in the reproductive cells of adults than in the leukocytes of children? Is starvation-induced telomere shortening a sex-dependent phenomenon? And would fasting regimens exerting beneficial effects be accompanied by telomere shortening in descendants?"

The team is currently considering experimental in vivo studies to answer these and other questions.

Further Information

Source and Contact

George Hunka, American Friends of Tel Aviv University"



New Ambassador who Crowdfunded for Immunotherapy Cancer Announced by ALIVIA

ALIVIA announces new ambassador Mo Haque who crowdfunded for immunotherapy cancer treatment and campaigns for more cancer treatment options:

  • Following AA Gill’s recent death after being denied access to life-extending immunotherapy

ALIVIA, a Swiss-founded Health Management Service that is revolutionizing the status quo of how society deals with healthcare, announces its new ambassador Mo Haque - a 33 year old Student Union worker who, after being diagnosed with stage 4 colon cancer, raised over £100,000 through crowdfunding to access life-extending immunotherapy treatment via his page

Haque actively supports ALIVIA's message that personalized healthcare is the only way to effectively treat diseases like cancer and that many lives could be extended and deaths could be avoided by obtaining a second opinion. He has been sharing his remarkable story across the country to help raise awareness of the options available to cancer patients.  

Having worked at Kingston University mentoring thousands of students, Haque was diagnosed in December 2014 and a year later, after 18 cycles of chemotherapy and major surgery, he was told the chemotherapy was not working and there was nothing the NHS could do for him.

A second opinion informed Haque that breakthrough immunotherapy treatment could offer him hope. A similar story to the late AA Gill’s recent cancer plight, but unfortunately, both Haque and Gill learned that the NHS would not pay for the treatment, which costs around £6,500 every three weeks.

Needing £200,000 to save his life, Haque began a crowdfunding campaign with the support of his friends and family. The love and support for him was overwhelming, as he visited mosques, community events, and made TV appeals, #TeamMo as he calls it, raised over £100,000 within a couple of months allowing immunotherapy treatment to begin. ALIVIA have been monitoring his progress as treatment continues.

Mo Haque says “I was devastated to learn from the NHS, that after receiving generic treatment, I had run out of options. Only after seeking a second opinion did I find out that immunotherapy could actually extend my life and treat my cancer effectively. This is why I am proud to support ALIVIA’s message that patients should always seek a second opinion and that personalised treatment for diseases like cancer is the only way. I want to spread awareness that cancer patients have more options than they realise and I would like to see our access to cancer treatment revolutionised and more lives saved. The cost of the treatment was so high, that I had to use my ideas and resources to access it, and I’m very grateful for every penny raised to support me. I am also grateful every day to be alive and hearing the news of AA Gill’s recent passing, and of others denied immunotherapy on the NHS, reinforces how fortunate I am to still be here to share my story.”

Richard Kensett, ALIVIA’s UK Managing Director said "With the sad passing of AA Gill and the incredible story of Mo Haque, awareness is spreading of the effectiveness, yet relative inaccessibility of immunotherapy treatment for cancer patients, as well as the often ineffectiveness of more generic, heavily prescribed cancer treatments. We at Alivia can prove that second opinions and personalised diagnostic tests before deciding on a treatment plan can extend lives. So we are proud to support and champion Mo’s campaign to create real change in this country’s approach to UK healthcare through thorough exploration of medical options for all patients."

Pembrolizumab is described as one of the most promising new immunotherapy drugs being used to treat cancer and is believed to have helped former US president Jimmy Carter to beat brain cancer last year. Unlike chemotherapy, it does not kill cancer cells directly, but boosts the immune system to do the job. However, the drug is only currently approved in the NHS as a treatment only for advanced melanoma skin cancer. More than 70 per cent of skin cancer patients were still alive a year after starting to receive it.

Similar to other types of cancer treatments, however, immunotherapy is not a “one size fits all.” Alivia advises all its cancer clients to use personalized diagnostic tests, including molecular profiling, to retrieve clinically actionable treatment information to determine if immunotherapy drugs are appropriate.

Alivia Swiss Health is a unique, new disruptive start-up in the healthcare sector - an external advisory service that provides a tailored offering through its robust and impartial interrogation of medical options and provision of truly independent medical intelligence on a global scale. ALIVIA is an industry first.

Unlike private medical insurance, ALIVIA is not bound by a set network, meaning medical intelligence is the deciding factor behind which physician and treatment is recommended – not quotas or contracts.

ALIVIA services patients with many different types of illnesses or diseases, although 70% of cases are cancer-related. The service offers a medical review, verification of diagnosis and identification of a leading international specialist for a second opinion whilst asking the right questions of consulting physicians and ensuring access to the top medical personnel and the very best treatment and rehabilitation the world over. By partnering with each and every patient, Alivia actually carries out ‘due diligence’ when seeking medical professionals and treatment.


Founded in Zurich in 2010 by a group of pioneering entrepreneurs, ALIVIA is the vision of Dr Vidar Arnulf, a board-certified anaesthesiologist from Norway with more than 30 years of leadership experience in the healthcare industry. This revolutionary group of medical and business minds share a passion and vision to optimise and sustain health, while extending lives.

With an extensive in house research team – the Medical Intelligence Unit - which is made up of doctors, radiologists, PHDs and other researchers based around the world, ALIVIA diligently analyses the medical files of each individual patient to verify the initial diagnosis, before researching the global market to identify the exact specialist who is best placed to handle each individual case and the most advanced research and treatment options available.

Having collected anecdotal evidence from its global team of medical professionals, ALIVIA revealed some surprising insights into patient behaviours.

  • Once diagnosed with an illness, the majority of patients in the UK fail to thoroughly interrogate their medical options according to their individual requirements – which is surprising for a society that is increasingly savvy about the many preventative medicines, treatments and lifestyle choices that can encourage and promote a healthier lifestyle both now and in later life.
  • We generally tend to spend more time researching the best car or household appliances to purchase, than investigating the doctors or hospitals we entrust with our lives.
  • Patients feel under-served by private medical insurance, which offer medical options within only a finite network, options that are not necessarily the best or most suitable option for the individual patient’s needs.

Alivia Swiss Health is the UK’s only personalised health management service that offers completely objective and independent advice and assistance, with access to the world’s most advanced medical practitioners and cutting-edge medical intelligence, offering patients a trusted partner at a time when they need it most.

Further Information

For more information about the services available through Alivia Swiss Health visit



Phantom Movements in Augmented Reality for Intractable Phantom Limb Pain

Dr Max Ortiz Catalan at Chalmers University of Technology has developed a novel method of treating phantom limb pain using machine learning and augmented reality. This approach has been tested on over a dozen of amputees with chronic phantom limb pain who found no relief by other clinically available methods before. The new treatment reduced their pain by approximately 50 per cent, reports a clinical study published in The Lancet.

People who lose an arm or leg often experience phantom limb pain, as if the missing limb was still there. Phantom limb pain can become a serious chronic condition that significantly reduces the patients’ quality of life. It is still unclear why phantom limb pain and other phantom sensations occur.

Several medical and non-medical treatments have been proposed to alleviate phantom limb pain. Examples include mirror therapy, various types of medications, acupuncture, and implantable nerve stimulators. However, in many cases nothing helps. This was the situation for the 14 arm amputees who took part in the first clinical trial of a new treatment, invented by Chalmers researcher Max Ortiz Catalan, and further developed with his multidisciplinary team in the past years.

“We selected the most difficult cases from several clinics,” Dr Ortiz Catalan says. “We wanted to focus on patients with chronic phantom limb pain who had not responded to any treatments. Four of the patients were constantly medicated, and the others were not receiving any treatment at all because nothing they tried had helped them. They had been experiencing phantom limb pain for an average of 10 years.”

The patients were treated with the new method for 12 sessions. At the last session the intensity, frequency, and quality of pain had decreased by approximately 50 per cent. The intrusion of pain in sleep and activities of the daily living was also reduced by half. In addition, two of the four patients who were on analgesics were able to reduce their doses by 81 per cent and 33 per cent.

“The results are very encouraging, especially considering that these patients had tried up to four different treatment methods in the past with no satisfactory results,” Ortiz Catalan says. “In our study, we also saw that the pain continuously decreased all the way through to the last treatment. The fact that the pain reduction did not plateau suggests that further improvement could be achieved with more sessions.”

Ortiz Catalan calls the new method phantom motor execution. It consist of using muscle signals from the amputated limb to control augmented and virtual environments. Electric signals in the muscles are picked up by electrodes on the skin. Artificial intelligence algorithms translate the signals into movements of a virtual arm in real-time. The patients see themselves on a screen with the virtual arm in the place of the missing arm, and they can control it as they would control their biological arm.

Thus, the perceived phantom arm is brought to life by a virtual representation that the patient can see and control. This allows the patient to reactivate areas of the brain that were used to move the arm before it was amputated, which might be the reason that the phantom limb pain decrease. No other existing treatment for phantom limb pain generates such a reactivation of these areas of the brain with certainty. The research led by Ortiz Catalan not only creates new opportunities for clinical treatment, but it also contributes to our understanding of what happens in the brain when phantom pain occurs.

The clinical trial was conducted in collaboration with Sahlgrenska University Hospital in Gothenburg, Örebro University Hospital in Örebro, Bräcke Diakoni Rehabcenter Sfären in Stockholm, all in Sweden, and the University Rehabilitation Institute in Ljubljana, Slovenia.

“Our joint project was incredibly rewarding, and we now intend to go further with a larger controlled clinical trial,” Ortiz Catalan says. “The control group will be treated with one of the current treatment methods for phantom limb pain. This time we will also include leg amputees. More than 30 patients from several different countries will participate, and we will offer more treatment sessions to see if we can make the pain go away completely.”

The technology for phantom motor execution is available in two modalities – an open source research platform, and a clinically friendly version in the process of being commercialised by the Gothenburg-based company Integrum. The researchers believe that this technology could also be used for other patient groups who need to rehabilitate their movement capability, for example after a stroke, nerve damage or hand injury.

Watch a video about how phantom motor execution works

More about: How the study was done

The patients were selected from three clinics in Sweden and one in Slovenia. They were treated with phantom motor execution twice a week for six weeks. They were asked to describe their pain levels before each treatment session and at follow-ups 1, 3 and 6 months after the end of treatment. To secure reliable pain measurements, several different ways of describing pain were employed, such as intensity, frequency, duration, quality, and the degree to which the pain affected sleep and daily activities.

More about: How phantom motor execution works

The treatment is based on a unique combination of several technologies Dr Max Ortiz Catalan and his team have developed:

  • Conversion of muscle signals (myoelectric) into movements in a virtual arm. Some part of the arm must remain intact in order for signals to be detected, and the more arm muscles remain, the easier is to decode more movements;
  • An augmented reality environment in which the patients see themselves on a screen with a virtual arm. Augmented reality is a combination of virtual reality and real information from the physical world. A fiducial marker on the stump allows the patient to move freely while the virtual arm follows along in the correct anatomical position;
  • A computer game that the patients use to train the brain to send movement signals to the missing arm, in a fun, rewarding way.

No one knows exactly what causes phantom limb pain, but it is thought to be caused by changes in the brain that occur when a limb is lost. Phantom motor execution allows the patient to reactivate areas of the brain that were used to move the missing limb. Max Ortiz Catalan hypothesized that this can reset the changes in the brain that cause phantom limb pain. He also believes that a complementary mechanism for the pain relief is that the patients are learning to better use the muscles in their arm stump, which requires brain resources. The processing of pain signals also requires brain resources. So it may be that the new brain activity created by using the muscles in the stump “outcompetes” pain processing.

More about: Advantages of the method

Phantom motor execution has a several advantages over other methods to treat phantom limb pain:

  • Creates an environment in which all parts fit together naturally. The patient’s desire to use the amputated limb activates the appropriate part of the brain and creates actual movement signals in the nerves and muscles of the stump, which leads to real-time visual feedback.
  • Requires no surgical intervention and has no known side effects at present;
  • Can be used even if both arms (or both legs) are amputated;
  • Allows recreation of most movements that a natural arm (or leg) can make;
  • Creates motivation using a computer game and precise measurements of the patient’s progress;
  • Has a low cost compared to invasive treatment methods used today.

More about: The Research

The paper Phantom motor execution facilitated by machine learning and augmented reality as treatment for phantom limb pain: a single group, clinical trial in patients with chronic intractable phantom limb pain was published online in the medical journal The Lancet on December 1.

Authors: Ortiz-Catalan M, Guðmundsdóttir RA, Kristoffersen MB, et al.

The study was a multidisciplinary collaboration between technical, medical, and industrial partners: Chalmers University of Technology (Gothenburg, Sweden), Sahlgrenska University Hospital (Gothenburg, Sweden), Örebro University Hospital (Örebro, Sweden), Bräcke Diakoni Rehabcenter Sfären (Stockholm, Sweden), University Rehabilitation Institute (Ljubljana, Slovenia), and Integrum AB (Mölndal, Sweden).

The study was funded by the Promobilia foundation, Vinnova, Jimmy Dahlstens Fond, Picosolve and Innovationskontor Väst.

Assistant Professor Max Ortiz Catalan recently founded the Biomechatronics and Neurorehabilitation Laboratory (Facebook and Twitter: @ChalmersBNL) at the Department of Signals and Systems, Chalmers University of Technology, where this work will continue.

Further Information

For more information, please contact: Max Ortiz Catalan, Department of Signals and Systems, Chalmers University of Technology, Sweden, +46 70 846 10 65,

Chalmers University of Technology conducts research and offers education in technology, science, shipping and architecture with a sustainable future as its global vision. Chalmers is well-known for providing an effective environment for innovation and has eight priority areas of international significance – Built Environment, Energy, Information and Communication Technology, Life Science Engineering, Materials Science, Nanoscience and Nanotechnology, Production, and Transport.  Graphene Flagship, an FET Flagship initiative by the European Commission, is coordinated by Chalmers. Situated in Gothenburg, Sweden, Chalmers has 10,300 full-time students and 3,100 employees.


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