Using graded motor imagery for complex regional pain syndrome in clinical practice: Failure to improve pain
Open Access
- 19 December 2011
- journal article
- research article
- Published by Wiley in European journal of pain
- Vol. 16 (4), 550-561
- https://doi.org/10.1002/j.1532-2149.2011.00064.x
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.Keywords
Funding Information
- National Health & Medical Research Council of Australia (571090)
This publication has 30 references indexed in Scilit:
- Does evidence support physiotherapy management of adult Complex Regional Pain Syndrome Type One? A systematic reviewEuropean Journal of Pain Supplements, 2009
- Interpreting the Clinical Importance of Treatment Outcomes in Chronic Pain Clinical Trials: IMMPACT RecommendationsThe Journal of Pain, 2008
- Reduction of pain-related fear in complex regional pain syndrome type I: The application of graded exposure in vivoPain, 2005
- Core outcome measures for chronic pain clinical trials: IMMPACT recommendationsPain, 2005
- Psychological aspects of persistent pain: current state of the scienceThe Journal of Pain, 2004
- Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trialPain, 2004
- Complex regional pain syndrome: mystery explained?The Lancet Neurology, 2003
- Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scalePain, 2001
- External validation of IASP diagnostic criteria for Complex Regional Pain Syndrome and proposed research diagnostic criteriaPain, 1999
- Development and preliminary validation of a pain measure specific to neuropathic painNeurology, 1997