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Graded Motor Imagery and the Impact on Pain Processing in a Case of CRPS

Walz, Andrea D. MSc*; Usichenko, Taras MD; Moseley, G. Lorimer PhD‡,§; Lotze, Martin MD*

doi: 10.1097/AJP.0b013e318250f4e8
Case Report

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.

Discussion: Our case report develops a design capable of differentiating cerebral changes associated with behavioral therapy of CRPS type I study.

Supplemental Digital Content is available in the text.

*Functional Imaging, Institute for Diagnostic Radiology and Neuroradiology

Department of Anesthesiology and Intensive Care Medicine, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany

Sansom Institute for Health Research, University of South Australia, Adelaide, SA

§Neuroscience Research Australia, Sydney, NSW, Australia

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Supported by a grant from the DFG (LO 795/10-1). G.L.M. is supported by the National Health & Medical Research Council of Australia (ID 571090). The authors declare no conflict of interest.

Reprints: Martin Lotze, MD, Functional Imaging Unit, Center for Diagnostic Radiology and Neuroradiology, University of Greifswald, Friedrich-Löffler-Straße 23a, D-17487 Greifswald, Germany (e-mail:

Received February 11, 2011

Accepted February 17, 2012

© 2013 Lippincott Williams & Wilkins, Inc.