Running title: Effect of graded motor imagery on chronic pain Indexing words:Graded motor imagery, GMI, mirror therapy, motor imagery left/right judgements, chronic pain, systematic review 2 AbstractGraded motor imagery (GMI) is becoming increasingly used in the treatment of chronic pain conditions. The objective of this systematic review was to synthesise all evidence concerning the effects of GMI and its constituent components on chronic pain. Systematic searches were conducted in 10 electronic databases. All randomised controlled trials (RCTs) of GMI, left/right judgement 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 judgement 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 favoured GMI in reducing pain (2 studies, n = 63; effect size 1.06 (0.41, 1.71); heterogeneity, I 2 = 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 synthesises 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.

People with chronic, idiopathic neck pain are worse than asymptomatic controls at head-to-neutral repositioning tests.

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Pain education is a popular treatment approach for persistent pain that involves learning a variety of concepts about pain (ie, target concepts), which is thought to be an important part of recovery. Yet, little is known about what patients value learning about pain. A mixed-methods survey was conducted to identify pain concepts that were valued by people with persistent pain who improved after a pain science education intervention. An online survey was distributed to 123 people who were treated for persistent pain with a pain science education approach; responses of participants who self-identified as “improved” were analysed. Open-ended survey questions were analysed using reflexive thematic analysis and close-ended questions were analysed for frequency of responses. Each question-type was analysed separately, before integration for complementarity. We analysed the data of 97 participants. We constructed 3 themes from the open-ended questions. Pain does not mean my body is damaged (theme 1) captured the importance of abandoning preexisting ideas that pain indicated damage. Thoughts, emotions and experiences affect pain (theme 2) captured the value of recognising multifactorial influences on pain. I can retrain my overprotective pain system (theme 3) captured the importance of conceptualising pain as a heightened protective response that could be lessened. Responses from close-ended questions confirmed that the target concepts represented by these themes are among those most valued, although divergence with the qualitative data suggests differences between patient and clinician language. These data offer patient-centred conceptualizations and language that could assist in further refining pain education interventions.