The Efficacy of Graded Motor Imagery and Its Components on Phantom Limb Pain and Disability: A Systematic Review and Meta-Analysis

Abstract

Introduction Graded Motor Imagery (GMI) is a non-invasive and inexpensive therapy used to treat Phantom Limb Pain (PLP) by sequentially activating motor networks in such a way that movement and pain are unpaired. The objective of this systematic review was to critically appraise relevant data on the efficacy of GMI and its components for reducing PLP and disability in amputees. Methods We searched 11 electronic databases for controlled trials investigating GMI and its components in amputees with PLP from inception until February 2023. Two reviewers independently screened studies and extracted relevant data. Study-level data were entered using the inverse variance function of the Review Manager 5 and pooled with the random effects model. Results Eleven studies with varying risk of bias were eligible. No eligible study considered left/right judgement tasks in isolation. Studies showed no effect for imagined movements, but positive effects were seen for GMI [weighted mean difference: -21.29 (95%CI: -31.55, -11.02), I 2 = 0%] and mirror therapy [weighted mean difference: -8.55 (95%CI: -14.74, -2.35, I 2 = 61%]. A comparison of mirror therapy versus sham showed no difference [weighted mean difference: -4.43 (95%CI: -16.03, 7.16), I 2 = 51%]. Conclusion Our findings suggest that GMI and mirror therapy may be effective for reducing PLP. However, this conclusion was drawn from a limited body of evidence, and the certainty of the evidence was very low. Therefore, rigorous, high-quality trials are needed to address the gap in the literature and inform practice.

A Computational Framework for Understanding the Impact of Prior Experiences on Pain Perception and Neuropathic Pain

“…If some of the sensory input could be restored, this could possibly offer an avenue for pain relief. Thus, our model offers a possible explanation for the working mechanism of existing non-pharmacological treatments for neuropathic pain involve some form of sensory restoration [35][36][37][38]. In addition to giving clues of possible avenues for pain prevention and relief, our model also offers a prediction for how different levels of sensory disruption may result in different pain characteristics.…”

“…This development of the model might also allow for exploration of the possible mechanism of treatments for neuropathic pain that involve some form of sensory restoration. One example of such a treatment is mirror therapy, which is commonly used for phantom limb pain [36,51]. Phantom limb pain is a particular form of neuropathic pain, where pain is experienced to arise in a missing limb, for example following amputation.…”

Novel Wearable Device for Mindful Sensorimotor Training: Integrating Motor Decoding and Somatosensory Stimulation for Neurorehabilitation

“…Another important aspect of rehabilitation for individuals with sensorimotor impairments is sensory training (ST). ST, intended as the training of somatosensory acuity, has the potential to reduce pain due to sensorimotor impairments and increase sensorimotor function [11,9,12,13]. The conventional way to provide ST is with the manual application of stimulations [14].…”

Novel Wearable Device for Mindful Sensorimotor Training: Integrating Motor Decoding and Somatosensory Stimulation for Neurorehabilitation

“…Another important aspect of rehabilitation for individuals with sensorimotor impairments is sensory training (ST) [2,9,10] ST, intended as the training of somatosensory acuity, has the potential to reduce pain due to sensorimotor impairments and increase sensorimotor function [7]. The conventional way to provide ST is with the manual application of stimulations [11].…”

“…A. Motor Execution M OTOR execution (ME) plays a crucial role in rehabilitation strategies for individuals with sensorimotor impairments [1,2,3,4]. Current rehabilitation approaches emphasize the promotion of motor recovery through task-oriented exercises and repetitive practice of functional movements.…”