CRPS1 Patients Benefit from Imagery

Standard treatment involves activating cortical networks that serve the affected limb through actual limb movement, but this is generally not effective, because movement produces intolerable pain.

The hypothesis was that by activating the cortical networks without limb movement, through imagining limb movement, patients with CRPS1 would experience reduced swelling and pain, and would proceed with standard mirror treatment with better effects and greater improvement.

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.

These results uphold the hypothesis that MIP initially not involving limb movement is effective for CRPS1. 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. What is underscored is the power of imagery to bring about the effects of movement in the body, and the benefits of movement, without actual movement.

Citation: Moseley GL.Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial. Pain. 2004 Mar;108(1-2):192-8. l.moseley@mailbox.uq.edu.au