Pain can be triggered or caused due to a variety of reasons – from muscle or joint injury or inflammation to nerve compression or irritation. It may only last a few days for some, while it may linger on for years for others. Regardless of the cause of pain, the brain and nervous system play a role in how people experience pain by processing and interpreting pain signals from the affected part of the body.
Focusing on this signalling mechanism, Dr Lorimer Moseley and David Butler from Australia, experts in the fields of pain science and physiotherapy, devised graded motor imagery, a novel technique developed in the early 2000s for pain management based on the concept of brain plasticity (the ability of the brain to remodel and adapt as a result of learning, experience, or injury by creating new neural connections).
Graded motor imagery helps people with chronic pain to rewire the brain’s responses to pain and movement, thereby reducing pain.
What is graded motor imagery?
Graded motor imagery, a treatment tool for chronic pain, is promoted by Neuro Orthopedic Institute (NOI), Australia, an active health resource network which focuses on pain management, neurodynamics, health performance, and manual therapy. The NOI was founded by Butler along with Dr Moseley.
“We classify conditions like Complex Regional Pain Syndrome (CRPS), earlier known as Reflex Sympathetic Dystrophy (RSD), and fibromyalgia, where the pain lasts longer than the healing period of three months, as chronic pain,” says Prakkash R Sharoff, a physiotherapist from Mumbai who also conducts graded motor imagery sessions in India for NOI. “When the time has passed for the structure to heal, we have observed that the nervous system plays a significant role in the overall pain experience.
“You cannot understand graded motor imagery without knowing the concept of ‘explain pain’,” adds Sharoff.
Explain pain is a knowledge-based approach that helps people comprehend the complicated nature of pain and its underlying causes. It relies on the idea that pain is a multidimensional experience influenced by numerous aspects, including the brain’s interpretation of sensory information, emotional responses, and prior experiences, rather than only being a result of an injury or damage.
Three stages of graded motor imagery
Graded motor imagery is conducted over a span of six weeks and three stages, each lasting two weeks (two hours per day). The following are the stages:
Laterality recognition is a test to check the ability to distinguish between images of the painful body part on the left or right. This ability is crucial for the pain rehabilitation process.
“Imagine someone suffered a hand injury six months ago. Then, it might be harder for them to distinguish between left and right,” says Sharoff. “We have a tool that allows us to assess an individual’s ability to distinguish between left and right, which tends to change when they are in pain for an extended period. The timing should be between 1 and 1.5 seconds to answer various components in the test. For accuracy, we anticipate a total score above 80%.”
Mirror neurons, which make up 25% of all brain cells, fire when you think about moving a painful body part. You employ the same brain regions when you imagine moving (when you actually move).
“In visual imagery, we make you visualize moving or using the painful body part and having it feel normal. By doing this, we are enlisting the same brain circuits that normally function when the component is being used,” adds Sharoff.
Mirror therapy is when they show you a reflection of the other side of the hurting body part. To convince the brain that moving the painful area is risk-free, mirror therapy reflects the movement of the opposite part moving effortlessly. As a result, the brain begins to get new input that moving the affected body part is comfortable and that no pain is emanating while doing so.
Unique approach of graded motor imagery
“The objectivity of graded motor imagery sets it apart from other therapies for pain management,” says Sharoff.
The way a person experiences pain can be influenced by brain activity. The individual who is in pain might not be aware of the brain component involved in their discomfort. The tests involved in graded motor imagery helps the subject understand how their brain contributes to the suffering or perception of pain. Additionally, it enables them to comprehend how their recovery progressed gradually over the course of the process.
- Graded motor imagery is a novel technique for pain management built on the idea of brain plasticity by helping people with chronic pain rewire their brain’s responses to pain.
- It is crucial to understand the concept of Explain Pain to understand graded motor imagery which aids in understanding the complexity of pain and its root causes.