Graded motor imagery is effective for long-standing complex regional pain syndrome


Complex regional pain syndrome type 1 (CRPS1) involves cortical abnormalities similar to those observed in phantom pain and after stroke. In those groups, treatment is aimed at activation of cortical networks that subserve the affected limb, for example mirror therapy. However, mirror therapy is not effective for chronic CRPS1, possibly because movement of the limb evokes intolerable pain. It was hypothesised that preceding mirror therapy with activation of cortical networks without limb movement would reduce pain and swelling in patients with chronic CRPS1. Thirteen chronic CRPS1 patients were randomly allocated to a motor imagery program (MIP) or to ongoing management. The MIP consisted of two weeks each of a hand laterality recognition task, imagined hand movements and mirror therapy. After 12 weeks, the control group was crossed-over to MIP. There was a main effect of treatment group (F(1,11)=57, P<0.01) and an effect size of ∼25 points on the Neuropathic pain scale. The number needed to treat for a 50% reduction in NPS score was ∼2. The effect of treatment was replicated in the crossed-over control subjects. The results uphold the hypothesis that a MIP initially not involving limb movement is effective for CRPS1 and support the involvement of cortical abnormalities in the development of this disorder. Although the mechanisms of effect of the MIP are not clear, possible explanations are sequential activation of cortical pre-motor and motor networks, or sustained and focussed attention on the affected limb, or both.

See full article at Pain 108(1-2): 192-198


  1. As you are aware I used mirror therapy before I had any knowledge of graded motor imagery, recognize etc.
    A physiotherapist gave me the Recognize program for computer. I did the tests with sometimes appalling results related to pain level at the time of the test. I slowed the test to the max but still couldn’t do well.
    I memorized some of the pictures and worked out the left or right answer (moving my hands into the positioned illustrated) and decided that the problem was my processing was slow. I just needed more time. I could have done the test using eg flash cards with no time limit. I decided then I could do with some practice so as I walked down along the beach putting my hands in different positions and saying left or right to myself. I was a bit stressed in my effort to get it right. I very quickly noticed that this caused me to perceive pain in the right wrist which was my initial injury (triple compound colles). I stopped. Each time I tried again the pain returned so I abandoned the exercise. I wish I’d known the recommended procedure. This makes much more sense.