title: Movement imagery increases pain in people with neuropathic pain following complete thoracic spinal cord injury.
abstract: Spinal cord injury (SCI) results in deafferentation and the onset of neuropathic pain in a substantial proportion of people. Based on evidence suggesting motor cortex activation results in attenuation of neuropathic pain, we sought to determine whether neuropathic SCI pain could be modified by imagined movements of the foot. Fifteen subjects with a complete thoracic SCI (7 with below-level neuropathic pain and 8 without pain) were instructed in the use of movement imagery. Movement imagery was practiced three times daily for 7days. On the eighth day, subjects performed the movement imagery in the laboratory and recorded pain ratings during the period of imagined movement. Six out of 7 subjects with neuropathic pain reported an increase in pain during imagined movements from 2.9+/-0.7 during baseline to 5.0+/-1.0 during movement imagery (p<0.01). In SCI subjects without neuropathic pain, movement imagery evoked an increase in non-painful sensation intensity from a baseline of 1.9+/-0.7 to 4.8+/-1.3 during the movement imagery (p<0.01). Two subjects without a history of pain or non-painful phantom sensations had onset of dysesthesia while performing imagined movements. This study reports exacerbation of pain in response to imagined movements and it contrasts with reports of pain reduction in people with peripheral neuropathic pain. The potential mechanisms underlying this sensory enhancement with movement imagery are discussed.
authors.affiliation: Department of Anatomy and Histology, F13, The University of Sydney, Sydney, NSW 2006, Australia Pain Management Research Institute, The University of Sydney, Royal North Shore Hospital, Sydney, NSW 2065, Australia Prince of Wales Medical Research Institute, Sydney, NSW 2031, Australia Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Sydney, NSW 2065, Australia.
authors.forename: Sylvia M
authors.initials: SM
authors.lastname: Gustin
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Wrigley
authors.forename: Simon C
authors.initials: SC
authors.lastname: Gandevia
authors.forename: James W
authors.initials: JW
authors.lastname: Middleton
authors.forename: Luke A
authors.initials: LA
authors.lastname: Henderson
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Siddall
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods*; D007092:Imagination / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009068:Movement / Q000502:physiology*; D010148:Intractable Pain / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D010523:Peripheral Nervous System Diseases / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D010591:Phantom Limb / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D013116:Spinal Cord / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D013904:Thoracic Vertebrae; D017211:Treatment Failure