Using graded motor imagery for complex regional pain syndrome in clinical practice: Failure to improve pain

Abstract

Background: There is good evidence from studies conducted in a single-centre research setting for the efficacy of graded motor imagery (GMI) treatment, a complex physiotherapy intervention, to reduce pain in long-standing complex regional pain syndrome (CRPS). However, whether GMI is effective in clinical practice is not established. Aim: To establish whether GMI is effective in clinical practice. Methods: We undertook a prospective audit of GMI treatment at two UK centres with a special interest in the management of patients with CRPS. All patients received GMI, in conjunction with a range of other 'best practice' physical and psychological interventions. Results: The patients' average pain intensities did not improve with treatment [centre 1: n = 20, pre-post numeric rating scale (NRS) difference 0.6 [confidence interval (CI) -0.3 to 1.5]; centre 2: n = 12, pre-post NRS difference 0.2 (CI: -0.9 to 1.2)]. Patients at centre 1 reported significant functional improvement. Improved performance on left/right judgement replicated in both centres seen in the clinical trials. Conclusions: The failure of our real-world implementation of GMI suggests that better understanding of both the GMI methodology and its interaction with other treatment methods is required to ensure that GMI research results can be translated into clinical practice. Our results highlight challenges with the translation of complex interventions for chronic pain conditions into clinical practice.

Effectiveness of Aquatic Physiotherapy in Clinical Practice

“…Effectiveness data are important as results from experimental studies do not always translate to real-world outcomes (Johnson, Hall, Barnett, Draper, Darbyshire, Haynes, & Goebel, 2012). Our results resonate with those of experimental and secondary paradigms in AP.…”

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

“…Prospective audit data from 32 patients treated at two interdisciplinary centres showed no reduction in pain after a multimodal approach that included GMI 16 ; indeed some patients (30% in one centre and 50% in the other) actually reported an increase in their pain intensity following treatment. The authors proposed that variations in GMI protocol from other studies and logistic constraints may have led to the poor result.…”

“…A recent systematic review evaluating interventions for treating CRPS supported the use of GMI 8 . However, a recent clinical audit of CRPS multimodal management including, but not limited to, GMI clearly showed no benefit of treatment 16 . These conflicting findings, and that GMI has not, to our knowledge, been empirically evaluated in a wider chronic pain population, highlight the importance of systematic evaluation of the entire literature concerning GMI and its components.…”

Imaging and Clinical Evidence of Sensorimotor Problems in CRPS: Utilizing Novel Treatment Approaches

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