Graded motor imagery and the impact on pain processing in a case of CRPS.
OBJECTIVE
Graded motor imagery (GMI) shows promising results for patients with complex regional pain syndrome (CRPS).


METHODS
In a case with chronic unilateral CRPS type I, we applied GMI for 6 weeks and recorded clinical parameters and cerebral activation using functional magnetic resonance imaging (fMRI; pre-GMI, after each GMI block, and after 6 mo). Changes in fMRI activity were mapped during movement execution in areas associated with pain processing. A healthy participant served as a control for habituation effects.


RESULTS
Pain intensity decreased over the course of GMI, and relief was maintained at follow-up. fMRI during movement execution revealed marked changes in S1 and S2 (areas of discriminative pain processing), which seemed to be associated with pain reduction, but none in the anterior insula and the anterior cingulate cortex (areas of affective pain processing). After mental rotation training, the activation intensity of the posterior parietal cortex was reduced to one third.


CONCLUSIONS
Our case report develops a design capable of differentiating cerebral changes associated with behavioral therapy of CRPS type I study.
Functional Imaging, Institute for Diagnostic Radiology and Neuroradiology, Greifswald, Germany.
Andrea D
AD
Walz
Taras
T
Usichenko
G Lorimer
GL
Moseley
Martin
M
Lotze
D000328:Adult; D005260:Female; D006801:Humans; D007092:Imagination; D009068:Movement; D058748:Pain Perception; D010470:Perceptual Masking; D012019:Reflex Sympathetic Dystrophy / Q000503:physiopathology* / Q000517:prevention & control*