Generating Much Interest (aka GMI)

Graded motor imagery (GMI) for the treatment of chronic pain has certainly been generating much interest recently. Earlier this year, I was lucky enough to publish a systematic review and meta-analysis – with a pretty snazzy bunch of researchers might I add – looking at the effects of GMI and its components on chronic pain. We published our article in the Journal of Pain and you can check it out here if you’d like (download the full PDF here).

Here is what we found in our review: left/right judgements and motor imagery, as a solo treatment, don’t do much in terms of decreasing pain. Mirror therapy seems to work okay. But by far the best treatment of the options we explored was the use of these three steps in a graded programme that we know as GMI.

About a month ago, the Journal of Pain released their ‘most read’ articles for this quarter year. I was like a little kid on Christmas Day when I found out that our article on GMI had pipped the second spot. Moments after I found out I received an excited ‘congratulations!’ email from Lorimer, telling me the paper had also been the third most downloaded paper of 2013. I turned into a kid on Christmas Day who’d had way too much sugar and not enough sleep. Ecstatic was an understatement.

I am intrigued, however, as to why our paper has gained so much attention. We found that when GMI is delivered by trained clinicians in a research setting, chronic limb pain can be reduced. But there is emerging evidence that this isn’t the case in the clinical setting. An article published earlier this year by Johnson et al demonstrates a failed attempt at using GMI in a clinical setting. So what are we missing? Why are our results in the research lab not translating to the clinic? I discussed some of these points in an earlier blog post, so you can have a squiz at that to see some of my thoughts.

In response to the popularity of the article, I started questioning why people were so interested in GMI if it doesn’t seem to work in the clinic? I argued (with my own thoughts, in my own head) that perhaps not everyone is finding GMI such a failure in the clinic. Perhaps some of you clinicians are succeeding – hence the hype on the paper. However, I’m also sure some clinicians are not – hence the published negative results.

I would love to know your experience with using GMI. What works? What doesn’t? Who has had some triumphs? Who has had some horrible failures? And most importantly, why? We don’t know how many of you are using GMI and how successfully you are using it unless you tell us.

The only way we can make GMI more successful in the clinic is by discussing what works and what doesn’t. So, if you’ve found something incredibly useful or something incredibly detrimental with GMI, please share!

Jane Bowering

grey Generating Much Interest (aka GMI)Jane has an addiction to Vegemite, loves ice-cream, and tuna (but only dolphin-free!), and has just started her PhD at BiM. After finishing her Physiotherapy degree with Honours and working clinically for a year, Jane is now back into pain. Researching, not inflicting, that is. She is interested in pelvic pain, but the rest of her PhD story is yet to unfold.

Reference

Bowering KJ, O’Connell NE, Tabor A, Catley MJ, Leake HB, Moseley GL, & Stanton TR (2013). The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. J Pain, 14 (1), 3-13 PMID: 23158879

Comments

  1. Matt Croger says:

    Hi Jane,

    Clinically my percentage of patients with neuropathic pain states/CRPS is low but I would love to see more! My experience with some of those who have failed before getting to me has been lack of good pain education delivered in conjunction with the GMI program and I think the education component is critical. I also think many clinicians also struggle to know exactly when is right to progress. It also takes a highly committed patient to complete appropriately and once again I think that’s where the education comes in

  2. stuart miller says:

    I have had success working with patients with CRPS in the 3 – 6 months stage even with Type 2 with GMI (usually upper extremity). I don’t see many patients years post with CRPS (they usually go through the Chronic Pain Centre). I have had challenges working with patients with chronic or complex elbow issues with pain in terms of how to incorporate GMI (Recognize doesn’t have pictures that I am aware of). I would like some advice – I have cut pictures out of magazines but perhaps I have more confidence using the NOI group info or information that looks more ‘professional’ – inspires confidence and perhaps I relay that. It sometimes seem that life stressors that are significant overwhelm some patients in trying to doing GMI especially getting started. I also have trouble determining what to tell patients who have resumed reasonable function and are managing who have gone through GMI whether they should do a ‘maintenance’ program with GMI especially if they are still protective to some degree. Please advise