Graded motor imagery can relieve phantom pain
NEW YORK (Reuters Health) - A therapeutic approach call graded motor imagery reduces the pain and disability in patients with phantom limb pain or complex regional pain syndrome type 1 (CRPS1), according to a report in the journal Neurology.
Findings such as these should make us all a bit more open minded about pain, Dr. G. Lorimer Moseley from the University of Oxford, UK, told Reuters Health. Graded motor imagery can be considered a therapeutic tool, but should only be used "within a sound clinical reasoning model."
Moseley notes that CRPS1 and phantom limb pain are classified as pathologic pain syndromes, because the pain seems unrelated to the underlying tissue damage. Therefore, the portion of the brain responsible for the perception of brain appears to be a reasonable target for treatment -- to "train the brain."
The researchers investigated whether a 6-week program of graded motor imagery would reduce pain and disability for a more general population of CRPS1 patients and for patients with phantom limb pain, and compared this approach to physiotherapy and usual care.
In the first phase of graded motor imagery, the patients assessed images of their limbs in various positions for the degree of pain they would expect to experience. In the next phase, they imagined moving the limbs in a smooth, painfree manner. Finally, they actually mimicked the movement.
At the end of the program, average pain (as measured on a 100-mm visual analog scale) had decreased by 23.4 mm in the treatment group and by 10.5 mm in the control group, Moseley reports.
The average scores on a specific task tailored to five patients improved by 2.2 points on a 10-point scale in the graded motor imagery group, compared with 0.6 points in the control group, the results indicate.
By the 6-month follow-up evaluation, the average decrease in pain was still much greater for the graded motor imagery group (32.1 mm) than for the control group (11.6 mm), Moseley found.
"It is not a panacea by any means, and some patients don't respond at all," Moseley said. He also advocates using graded motor imagery with cognitive behavioral support and reassurance.
Moseley concludes: "Although evidence is emerging that treatments such as graded motor imagery and sensory discrimination training can be effective for pathologic pain, further studies are needed to replicate the current data and elucidate the mechanisms involved."
SOURCE: Neurology, December 26, 2006.
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