Graded motor imagery for chronic pain

Abstract

Background: Phantom limb and complex regional pain syndrome type 1 (CRPS1) are characterized by changes in cortical processing and organization, perceptual disturbances, and poor response to conventional treatments. Graded motor imagery is effective for a small subset of patients with CRPS1.

Objective: To investigate whether graded motor imagery would reduce pain and disability for a more general CRPS1 population and for people with phantom limb pain.

Methods: Fifty-one patients with phantom limb pain or CRPS1 were randomly allocated to motor imagery, consisting of 2 weeks each of limb laterality recognition, imagined movements, and mirror movements, or to physical therapy and ongoing medical care.

Results: There was a main statistical effect of treatment group, but not diagnostic group, on pain and function. The mean (95% CI) decrease in pain between pre- and post-treatment (100 mm visual analogue scale) was 23.4 mm (16.2 to 30.4 mm) for the motor imagery group and 10.5 mm (1.9 to 19.2 mm) for the control group. Improvement in function was similar and gains were maintained at 6-month follow-up.

Conclusion: Motor imagery reduced pain and disability in these patients with complex regional pain syndrome type I or phantom limb pain, but the mechanism, or mechanisms, of the effect are not clear.

See full article at Neurology 67: 2129-34

Comments

  1. Peter Andersson says:

    Hi Lorimer!

    Found an intersesting, to me new “phenomena” while working , starting up GMI on a patient with pathologic pain in her left arm, hand(my conclusion).

    Coming to step 2, look at images try to imagine movements, positions, patient reported no pain but also an intersting point. While closing her eyes imagining movements with her healthy arm, hand she could visualise her arm. Trying to do the same thing with her affected side she couldn´t visualise that arm, hand for her “inner eye. “It´s just a black spot”.

    I don´t know if you have to be able to “see” your affected bodypart for your “inner eye” to activate pre motor, motor cortices or if it is enough just to give the mental comand to move that part. My guess is that you don´t have to “see”, but of course I don´t know.

    Can´t help but wondering…if that diffrence, not beeing able to “see” that side, could be a sign of even more “programelocks”-protective responses? or possible an inner sign of imobilisation-cortical distortions? Is she not “allowed” to activate motor cortises this way=no pain?

    She can move her arm, hand but hardly won´t because of severe, longstanding elevated painlevel.

    All the best…
    Peter/PT/Sweden

    Lorimer Reply:

    Really interesting stuff Peter. I like your idea – i guess it would be worth us all just asking patients about that – the whole closing the eyes and visualise the limb thing. Any takers?

    sarah Reply:

    Hi there,

    I am not currently working in a pain centre, however I was previously. I spent a great deal of time and effort attempting to get a graded motor imagery programme off the ground for people with CRPS and I’m still quite passionate about it.
    What Peter has described above was a factor for all of the patients I can recall that I worked with using the GMI approach. They would describe not being able to “see” the limb from the approximate point where other symptoms were apparent. I wondered about a link between the lack of activity in the somatosensory cortex re. the affected limb as seen on fMRI and this experience that people reported. The more “chronic” patients seemed to need quite some time spent on comparing the pictures in the limb laterality exercises to their own limbs in order to be able to begin to make choices about whether a left or right limb was represented. I could only guess that this was due to their inability to “access” the “invisible” part of the limb.