Graded Motor Imagery for Refractory Phantom Limb Pain After Traumatic Amputation: A Review of the Trial Evidence
DOI:
https://doi.org/10.5281/zenodo.22549308Keywords:
Graded motor imagery, Phantom limb pain, Mirror therapy, Traumatic amputation, Cortical reorganization, Refractory painAbstract
Phantom limb pain affects a substantial proportion of people following traumatic amputation and is often
refractory to conventional pharmacological management. Graded motor imagery, a structured
three-stage intervention progressing from laterality recognition through explicit motor imagery to mirror
therapy, has accumulated a growing randomised and observational trial literature since its original
description in complex regional pain syndrome. This review synthesises the trial evidence for graded
motor imagery and its component techniques specifically in phantom limb pain after traumatic
amputation, including proposed cortical mechanisms, reported effect sizes, and factors associated with
favourable response.
References
Moseley GL. "Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial". Pain 108(2004):192-198.
Moseley GL. "Is successful rehabilitation of complex regional pain syndrome due to sustained attention to the affected limb? A randomised clinical trial". Pain 114(2005):54-61.
Moseley GL. "Graded motor imagery for pathologic pain: a randomized controlled trial". Neurology 67(2006):2129-2134.
MacIver K, Lloyd DM, Kelly S, Roberts N, Nurmikko T. "Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery". Brain 131(2008):2181-2191.
Ramachandran VS, Rogers-Ramachandran D. "Synaesthesia in phantom limbs induced with mirrors". Proc Biol Sci 263(1996):377-386.
Chan BL, Witt R, Charrow AP, et al. "Mirror therapy for phantom limb pain". N Engl J Med 357(2007):2206-2207.
Flor H, Nikolajsen L, Jensen TS. "Phantom limb pain: a case of maladaptive CNS plasticity?" Nat Rev Neurosci 7(2006):873-881.
Flor H, Elbert T, Knecht S, et al. "Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation". Nature 375(1995):482-484.
Sumitani M, Miyauchi S, McCabe CS, et al. "Mirror visual feedback alleviates deafferentation pain". Pain 138(2008):7-10.
Foell J, Bekrater-Bodmann R, Diers M, Flor H. "Mirror therapy for phantom limb pain: brain changes and the role of body representation". Eur J Pain 18(2014):729-739.
Barbin J, Seetha V, Casillas JM, Paysant J, Perennou D. "The effects of mirror therapy on pain and motor control of phantom limb in amputees: a systematic review". Ann Phys Rehabil Med 59(2016):270-275.
Wittkopf PG, Johnson MI. "Mirror therapy: a potential intervention for pain management". Rev Assoc Med Bras 63(2017):1000-1005.
Rothgangel AS, Braun SM, Beurskens AJ, Seitz RJ, Wade DT. "The clinical aspects of mirror therapy in rehabilitation: a systematic review of the literature". Int J Rehabil Res 34(2011):1-13.
Ephraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin LE. "Phantom pain, residual limb pain, and back pain in amputees: results of a national survey". Arch Phys Med Rehabil 86(2005):1910-1919.
Sherman RA, Sherman CJ, Parker L. "Chronic phantom and stump pain among American veterans: results of a survey". Pain 18(1984):83-95.
Nikolajsen L, Jensen TS. "Phantom limb pain". Br J Anaesth 87(2001):107-116.
Subedi B, Grossberg GT. "Phantom limb pain: mechanisms and treatment approaches". Pain Res Treat 2011(2011):864605.
Halligan PW. "Phantom limbs: the body in mind". Cogn Neuropsychiatry 7(2002):251-269.
Wilcher DG, Chernev I, Yan K. "Combined mirror visual and auditory feedback therapy for upper limb phantom pain: a case report". J Med Case Rep 5(2011):41.
Kikkert S, Johansen-Berg H, Tracey I, Makin TR. "Reaffirming the link between chronic phantom limb pain and maintained missing hand representation". Cortex 106(2018):174-184.
Makin TR, Scholz J, Filippini N, Henderson Slater D, Tracey I, Johansen-Berg H. "Phantom pain is associated with preserved structure and function in the former hand area". Nat Commun 4(2013):1570.
Collins KL, Russell HG, Schumacher PJ, et al. "A review of current theories and treatments for phantom limb pain". J Clin Invest 128(2018):2168-2176.
Limakatso K, Bedwell GJ, Madden VJ, Parker R. "The prevalence and risk factors for phantom limb pain in people with amputations: a systematic review and meta-analysis". PLoS One 15(2020):e0240431.
Dijkstra PU, Geertzen JH, Stewart R, van der Schans CP. "Phantom pain and risk factors: a multivariate analysis". J Pain Symptom Manage 24(2002):578-585.
Griffin SC, Alphonso AL, Tung M, et al. "Trajectory of phantom limb pain relief using mirror therapy: a case series". Pain Med 18(2017):1177-1186.
Finn SB, Perry BN, Clasing JE, et al. "A Randomized, Controlled Trial of Mirror Therapy for Upper Extremity Phantom Limb Pain in Male Amputees". Front Neurol 8(2017):267.
Herrador Colmenero L, Perez Marmol JM, Marti-Garcia C, et al. "Effectiveness of mirror therapy, motor imagery, and virtual feedback on phantom limb pain following amputation: a systematic review". Prosthet Orthot Int 42(2018):288-298.
Batsford S, Ryan CG, Martin DJ. "Non-pharmacological conservative therapy for phantom limb pain: a systematic review of randomized controlled trials". Physiother Theory Pract 33(2017):173-183.
Ortiz-Catalan M, Gudmundsdottir RA, Kristoffersen MB, et al. "Phantom motor execution facilitated by machine learning and augmented reality as treatment for phantom limb pain: a single group, clinical trial". Lancet 388(2016):2885-2894.
Timmermann JG, Sluka KA. "Phantom limb pain: pathophysiological mechanisms and their implications for graded, sequential rehabilitation approaches". J Pain Res 12(2019):1311-1320.
