Advertisement

The Effects of Graded Motor Imagery and Its Components on Chronic Pain: A Systematic Review and Meta-Analysis

Published:November 19, 2012DOI:https://doi.org/10.1016/j.jpain.2012.09.007

      Abstract

      Graded motor imagery (GMI) is becoming increasingly used in the treatment of chronic pain conditions. The objective of this systematic review was to synthesize all evidence concerning the effects of GMI and its constituent components on chronic pain. Systematic searches were conducted in 10 electronic databases. All randomized controlled trials (RCTs) of GMI, left/right judgment training, motor imagery, and mirror therapy used as a treatment for chronic pain were included. Methodological quality was assessed using the Cochrane risk of bias tool. Six RCTs met our inclusion criteria, and the methodological quality was generally low. No effect was seen for left/right judgment training, and conflicting results were found for motor imagery used as stand-alone techniques, but positive effects were observed for both mirror therapy and GMI. A meta-analysis of GMI versus usual physiotherapy care favored GMI in reducing pain (2 studies, n = 63; effect size, 1.06 [95% confidence interval, .41, 1.71]; heterogeneity, I2 = 15%). Our results suggest that GMI and mirror therapy alone may be effective, although this conclusion is based on limited evidence. Further rigorous studies are needed to investigate the effects of GMI and its components on a wider chronic pain population.

      Perspective

      This systematic review synthesizes the evidence for GMI and its constituent components on chronic pain. This review may assist clinicians in making evidence-based decisions on managing patients with chronic pain conditions.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bray H.
        • Moseley G.L.
        Disrupted working body schema of the trunk in people with back pain.
        Br J Sports Med. 2009; 45: 168-173
        • Cacchio A.
        • De Blasis E.
        • Necozione S.
        • di Orio F.
        • Santilli V.
        Mirror Therapy for Chronic Complex Regional Pain Syndrome Type 1 and Stroke.
        N Engl J Med. 2009; 361: 634-636
        • Chan B.L.
        • Witt R.
        • Charrow A.P.
        • Magee A.
        • Howard R.
        • Pasquina P.F.
        • Heilman K.M.
        • Tsao J.W.
        Mirror therapy for phantom limb pain.
        N Engl J Med. 2007; 357: 2206-2207
      1. The Cochrane Collaboration. 2011. Review Manager (RevMan), Version 5.1

        • Coslett H.
        • Medina J.
        • Kliot D.
        • Burkey A.
        Mental motor imagery and chronic pain: The foot laterality task.
        JINS. 2010; 16: 603
        • Coslett H.B.
        • Medina J.
        • Kliot D.
        • Burkey A.R.
        Mental motor imagery indexes pain: The hand laterality task.
        Eur J Pain. 2010; 14: 1007-1013
        • Daly A.E.
        • Bialocerkowski A.E.
        Does evidence support physiotherapy management of adult Complex Regional Pain Syndrome Type One? A systematic review.
        Eur J Pain. 2009; 13: 339-353
        • Decety J.
        The neurophysiological basis of motor imagery.
        Behavl Brain Res. 1996; 77: 45-52
        • Flor H.
        • Denke C.
        • Schaefer M.
        • Grusser S.
        Effect of sensory discrimination training on cortical reorganisation and phantom limb pain.
        Lancet. 2001; 357: 1763-1764
        • Flor H.
        • Elbert T.
        • Braun C.
        • Birbaumer N.
        Extensive cortical reorganization in chronic back pain patients.
        NeuroImage. 1997; 5: S216
        • Flor H.
        • Elbert T.
        • Knecht S.
        • Wienbruch C.
        • Pantev C.
        • Birbaumer N.
        • Larbig W.
        • Taub E.
        Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation.
        Nature. 1995; 375: 482-484
        • Florence S.L.
        • Jain N.
        • Kaas J.H.
        Plasticity of Somatosensory Cortex in Primates.
        Seminars in Neuroscience. 1997; 9: 3-12
        • Huse E.
        • Preissl H.
        • Larbig W.
        • Birbaumer N.
        Phantom limb pain.
        The Lancet. 2001; 358: 1015
        • Johnson S.
        • Hall J.
        • Barnett S.
        • Draper M.
        • Derbyshire G.
        • Haynes L.
        • Rooney C.
        • Cameron H.
        • Moseley G.L.
        • de C. Williams A.C.
        • McCabe C.
        • Goebel A.
        Using graded motor imagery for complex regional pain syndrome in clinical practice: Failure to improve pain.
        Eur J Pain. 2012; 16: 550-561
        • Juottonen K.
        • Gockel M.
        • Silén T.
        • Hurri H.
        • Hari R.
        • Forss N.
        Altered central sensorimotor processing in patients with complex regional pain syndrome.
        Pain. 2002; 98: 315-323
        • Machado L.
        • Kamper S.
        • Herbert R.
        • Maher C.
        • McAuley J.
        Imperfect placebos are common in low back pain trials: a systematic review of the literature.
        Eur Spine J. 2008; 17: 889-904
        • Maihofner C.
        • Handwerker H.
        • Neundorfer B.
        • Birklein F.
        Patterns of cortical reorganization in complex regional pain syndrome.
        Neurology. 2003; 61: 1707-1715
        • Matthys K.
        • Smits M.
        • Van der Geest J.N.
        • Van der Lugt A.
        • Seurinck R.
        • Stam H.J.
        • Selles R.W.
        Mirror-Induced Visual Illusion of Hand Movements: A Functional Magnetic Resonance Imaging Study.
        Arch Phys Med Rehabil. 2009; 90: 675-681
        • Melzack R.
        Phantom limbs and the concept of a neuromatrix.
        Trends Neurosci. 1990; 13: 88-92
        • Melzack R.
        • Israel R.
        • Lacroix R.
        • Schultz G.
        Phantom limbs in people with congenital limb deficiency or amputation in early childhood.
        Brain. 1997; 120: 1603-1620
        • Michielsen M.E.
        • Selles R.W.
        • van der Geest J.N.
        • Eckhardt M.
        • Yavuzer G.
        • Stam H.J.
        • Smits M.
        • Ribbers G.M.
        • Bussmann J.B.J.
        Motor Recovery and Cortical Reorganization After Mirror Therapy in Chronic Stroke Patients.
        Neurorehabil Neural Repair. 2011; 25: 223-233
        • Moore R.A.
        • Eccleston C.
        • Derry S.
        • Wiffen P.
        • Bell R.F.
        • Straube S.
        • McQuay H.
        “Evidence” in chronic pain – establishing best practice in the reporting of systematic reviews.
        Pain. 2010; 150: 386-389
        • Moseley G.L.
        Graded motor imagery for pathologic pain: a randomized controlled trial.
        Neurology. 2006; 67: 2129-2134
        • Moseley G.L.
        Graded motor imagery is effective for long-standing complex regional pain syndrome: A randomised controlled trial.
        Pain. 2004; 108: 192-198
        • Moseley G.L.
        I can't find it! Distorted body image and tactile dysfunction in patients with chronic back pain.
        Pain. 2008; 140: 239-243
        • Moseley G.L.
        Is successful rehabilitation of complex regional pain syndrome due to sustained attention to the affected limb? A randomised clinical trial.
        Pain. 2005; 114: 54-61
        • Moseley G.L.
        • Gallagher L.
        • Gallace A.
        Neglect-like tactile dysfunction in chronic back pain.
        Neurology. 2012; 79: 327-332
        • Moseley G.L.
        Why do people with complex regional pain syndrome take longer to recognize their affected hand?.
        Neurology. 2004; 62: 2182-2186
        • Moseley G.L.
        • Acerra N.
        Complex regional pain syndrome is associated with distorted body image of the affected part.
        J Neurol Sci. 2005; 238: S501
        • Moseley G.L.
        • Flor H.
        Targeting Cortical Representations in the Treatment of Chronic Pain.
        Neurorehabil Neural Repair. 2012; 26: 646-652
        • Moseley G.L.
        • Gallace A.
        • Spence C.
        Space-based, but not arm-based, shift in tactile processing in complex regional pain syndrome and its relationship to cooling of the affected limb.
        Brain. 2009; 132: 3142-3151
        • Moseley G.L.
        • Wiech K.
        The effect of tactile discrimination training is enhanced when patients watch the reflected image of their unaffected limb during training.
        Pain. 2009; 144: 314-319
        • Moseley G.L.
        • Zalucki N.
        • Birklein F.
        • Marinus J.
        • van Hilten J.J.
        • Luomajoki H.
        Thinking about movement hurts: The effect of motor imagery on pain and swelling in people with chronic arm pain.
        Arthritis Rheum. 2008; 59: 623-631
        • Moseley G.L.
        • Zalucki N.M.
        • Wiech K.
        Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain.
        Pain. 2008; 137: 600-608
        • Parsons L.M.
        • Fox P.T.
        • Downs J.H.
        • Glass T.
        • Hirsch T.B.
        • Martin C.C.
        • Jerabek P.A.
        • Lancaster J.L.
        Use of implicit motor imagery for visual shape discrimination as revealed by PET.
        Nature. 1995; 375: 54-58
      2. Physiotherapy Evidence Database. 1999. PEDro scale. http://www.pedro.org.au/english/downloads/pedro-scale/

        • Richter H.O.
        • Röijezon U.
        • Björklund M.
        • Djupsjöbacka M.
        Long-term adaptation to neck/shoulder pain and perceptual performance in a hand laterality motor imagery test.
        Perception. 2010; 39: 119-130
        • Schwoebel J.
        • Coslett H.
        • Bradt J.
        • Friedman R.
        • Dileo C.
        Pain and the body schema: effects of pain severity on mental representations of movement.
        Neurology. 2002; 59: 775-778
        • Schwoebel J.
        • Friedman R.
        • Duda N.
        • Coslett H.B.
        Pain and the body schema: Evidence for peripheral effects on mental representations of movement.
        Brain. 2001; 124: 2098-2104
      3. Cohen J. Statistical Power Analysis for the Behavioural Sciences. Lawrence Erlbaum Associates, Inc, Mahwah, NJ1988
        • Vingerhoets G.
        • de Lange F.P.
        • Vandemaele P.
        • Deblaere K.
        • Achten E.
        Motor Imagery in Mental Rotation: An fMRI Study.
        Neuroimage. 2002; 17: 1623-1633
        • Walz A.D.
        • Usichenko T.
        • Moseley G.L.
        • Lotze M.
        Graded Motor Imagery and the Impact on Pain Processing in a Case of CRPS.
        Clin J Pain. 2012 Aug 21; ([Epub ahead of print])
        • Wand B.M.
        • O'Connell N.E.
        • Di Pietro F.
        • Bulsara M.
        Managing Chronic Nonspecific Low Back Pain With a Sensorimotor Retraining Approach: Exploratory Multiple-Baseline Study of 3 Participants.
        Phys Ther. 2011; 91: 535-546
        • Wand B.M.
        • Parkitny L.
        • O'Connell N.E.
        • Luomajoki H.
        • McAuley J.H.
        • Thacker M.
        • Moseley G.L.
        Cortical changes in chronic low back pain: Current state of the art and implications for clinical practice.
        Man Ther. 2011; 16: 15-20
        • Zacks J.
        • Rypma B.
        • Gabrieli J.D.E.
        • Tversky B.
        • Glover G.H.
        Imagined transformations of bodies: an fMRI investigation.
        Neuropsychologia. 1999; 37: 1029-1040