Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial
Abstract
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 approximately 25 points on the Neuropathic pain scale. The number needed to treat for a 50% reduction in NPS score was approximately 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.
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Graded Motor Imagery may reduce pain and enhance limb function better than conservative physiotherapy.
“GMI may reduce pain and enhance limb function better than conservative physiotherapy [11]”
From Symptom reduction and improved function in chronic CRPS type 1 after 12-week integrated, interdisciplinary therapy (2019) · cites this paper as [11]
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- Authors
- Moseley, L. G.
- Venue
- Pain
- Published
- 2004-03
- Volume
- 108
- Issue
- 1
- Pages
- 192-198
- ISSN
- 0304-3959 (ISSN-L)
- OpenAlex
- W2171940221
- Cited by
- 681
- References
- 42
- Citations by year
- 2026: 19 · 2025: 32 · 2024: 20 · 2023: 35 · 2022: 30 · 2021: 31 · 2020: 32 · 2019: 27 · 2018: 37 · 2017: 45 · 2016: 38 · 2015: 39 · 2014: 35 · 2013: 41 · 2012: 44
- FWCI
- 20.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- complex regional pain syndrome type I, graded motor imagery, mirror therapy, cortical abnormalities, neuropathic pain, phantom pain, chronic pain
- MeSH terms
- Adolescent, Adult, Chronic Disease, Female, Humans, Male, Middle Aged, Motor Cortex, Reflex Sympathetic Dystrophy, Treatment Outcome, Cross-Over Studies, Imagery, Psychotherapy, Physical Therapy Modalities
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