Modified graded motor imagery for complex regional pain syndrome type 1 of the upper extremity in the acute phase

Abstract

Complex regional pain syndrome (CRPS) is a pathologic condition in which the painful experience is disproportionate in time and intensity in comparison with the inciting event. At present, the pathophysiology of CRPS is not well understood. Several studies have indicated that cortical reorganization plays a role in the persistence of the symptoms. A new promising approach, graded motor imagery (GMI), seems to be effective, but there are limited data for the CRPS-1 upper extremity population. The aim of this study was to demonstrate the effectiveness of a modified GMI (mGMI) protocol based on the work of Moseley to reduce pain and enhance functional capacities for a population with nonchronic CRPS-1 of the upper extremity. The following outcome measures were used to assess the clinical effectiveness: pain (short form of the McGill Pain Questionnaire), grip force (Martin vigorimeter), perception of upper extremity function (Disabilities of the Arm, Shoulder and Hand Questionnaire), and patient's global impression of change. All outcomes at T4 were compared with the baseline data (T0) using the Mann-Whitney test and the χ test (nonparametric tests). Seven patients were recruited for the study. At the end of the mGMI (T4), we obtained significant results for the decrease in the pain experienced in the last 7 days (visual analog scale; P=0.046), improvement in the affected extremity grip force (P=0.042), and the patient's global impression of change (P=0.015). However, the data of the perception of upper extremity function (Disabilities of the Arm, Shoulder and Hand Questionnaire) were not clinically or statistically significant. Our results indicate that this mGMI protocol seems to be a promising therapeutic modality to reduce pain. However, more investigations are needed to determine whether mGMI has a significant impact on upper extremity function.

Graded motor imagery for women at risk for developing type I CRPS following closed treatment of distal radius fractures: a randomized comparative effectiveness trial protocol

“…Although the GMI intervention reported by Mosely had significant functional, pain-reducing, and edema-reducing benefits, it may have limited feasibility as it requires performing a home program for 10 min each waking hour. For this reason, Lagueux et al [ 53 ] designed and implemented a modified approach to GMI with three 10 min sessions performed daily. In a six-week program, persons with acute type 1 CRPS reported significantly less pain ( p = 0.046) on McGill Pain Questionnaire, and improved maximum grip strength measured by dynamometry ( p = 0.040).…”

“…In a six-week program, persons with acute type 1 CRPS reported significantly less pain ( p = 0.046) on McGill Pain Questionnaire, and improved maximum grip strength measured by dynamometry ( p = 0.040). The present protocol is based on the modified GMI (mGMI) approach by Lagueax et al [ 53 ] which involved four stages of: 1) Laterality, 2) Explicit motor imagery, 3) Mirror therapy with unaffected hand only and 4) Mirror therapy with bilateral hands. The present study will only involve use the first three phases, given the constraint of cast immobilization.…”

Motor imagery and its effect on complex regional pain syndrome: an integrative review

“…The MI technique has had a significant effect of reducing pain in CRPS-1 after hand fracture, 26 , 29-32 decreasing the intensity of pain and promoting increased functionality, 21 , 26 ,31,32,47, 48 that can be maintained even after 6 months of intervention (see Table 1 ). 32 However, some individuals, who have suffered spinal cord injury, 49 or chronic CRPS in the arm, 29 cannot benefit from the use of MI because there are still flaws in their use.…”

The Effectiveness of Transcranial Direct Current Stimulation as an Add-on Modality to Graded Motor Imagery for Treatment of Complex Regional Pain Syndrome

“…The participants performed the GMI therapy at home, 10 minutes per session, 3 times per day, 6 times a week, for 6 weeks. 23 The description and settings of the GMI process are detailed in appendix (see Appendix A, Supplemental Digital Content 1, http://links.lww.com/CJP/A446 ). Before the beginning of each phase, the clinician carefully explained the GMI program to the participant.…”

“…14,16,17 But many audited patients in these previous studies reported that complying with exercises every waking hour was not feasible for them (75% compliance rate was reported). Our methodological choice regarding the frequency of the exercises was based on previous positive findings 23 and the fact that this exercise regimen was more respectful of their daily routine and quality of life during the intervention. 29,54 This methodological choice also probably contributed to the perfect compliance we observed for our two groups.…”