Back Pain Relief With Graded Motor Imagery


There is research going on in the field of pain that is trying to find out why some people suffer from chronic pain and some do not. The immune system varies from one person to another, and different people react differently to injury. The brain also reacts differently to injury, which varies from person to person. The medical practitioners are constantly researching for new methods of curing chronic pain and back pain. Back pain relief with graded motor imagery is one such treatment that is used to treat many patients.



Back Pain Relief With Graded Motor Imagery


Back pain relief with graded motor imagery is a ground breaking treatment that is used on patients with chronic pain.

Ken Ng was 12 when he had his left leg amputated below the knee to stop the spread of bone cancer. It was the start of a long journey of pain. Phantom sensations from his amputated limb haunted him as a teenager, including stabbing sensations and a vice-like constriction around his stump. It got worse when he moved to Wellington to begin studying for his law degree. By 2009, the sensations flooding in from his absent limb were consuming him.

Each day he downed a succession of prescription painkillers – codeine, tramadol, Neurofen and Voltaren. “I couldn’t really study any more, I couldn’t sit my exams. It made me introverted, I didn’t want anything to do with people. I wasn’t eating, I stopped going to lectures and the tramadol was making me hallucinate.” Ng sought help from his GP, who referred him to Capital & Coast District Health Board’s pain clinic. Luckily for Ng, the clinic had just begun to offer a simple but revolutionary new therapy, which recognises that some types of chronic pain are caused not by tissue damage but by changes in the wiring of the brain. Ng started his treatment with two weeks of computer exercises looking at pictures of right and left legs, and then began mirror therapy.


Ng’s occupational therapist, Maria Polaczuk, seated him with a large mirror positioned upright between his legs so it reflected his whole right leg. “All I could see was two bare normal legs. I massaged my right foot with my hands, manipulated it up and down. I was getting a sense of what a foot felt like.” As he looked at this reflected whole leg in the mirror, where usually he would see an amputated limb, something strange started to happen. “The tingling painful sensation in my stump started to fade and become less prominent.”


After two weeks of mirror exercises, four times a day, the phantom pain disappeared altogether. Now 22, Ng has been able to stop taking painkillers. He has had one brief attack of phantom pain, after a period of stress, but apart from that he experiences only the more routine discomfort of pressure on his stump from his prosthesis. Mirror therapy is one byproduct of a great leap forward in science’s understanding of pain and how it is manufactured in the human brain.


Graded motor imagery is offered by about 100 physiotherapists and occupational therapists around New Zealand, and began here three years ago after Moseley and Butler gave conference presentations. It is focused on types of pain present on just one side of the body, particularly in limbs, in conditions such as phantom limb pain, brachial plexus tears and complex regional pain syndrome. It doesn’t work for everyone, as it takes concentration and effort, but for those who have success the results can be dramatic.


“I’ve been consulting on a lady who has a complex pain-syndrome problem in her left hand. If I show her a picture of a left hand and ask her if it is left or right, she’ll go into a panic attack. The brain has worked out that it needs to protect that hand, and if protection means closing down some of the basic elements of movement, like judging whether it is left or right, or planning movement, the brain will actually do it.” For patients like this, an even gentler first step of therapy is watching others moving the affected limb, such as on television or in a film. The final step in graded motor imagery is mirror work, which can correct the neural representation of the reflected limb. With a phantom limb like Ng’s, the brain’s representation of th absent limb becomes “smudged”, generating pain.


Butler, who is a physiotherapist, says a strong body of research has established some of the common factors for those who develop chronic pain conditions. “Firstly, simply a belief that pain equals damage. The second thing that produces chronic pain is something called fear avoidance, where people are fearful of movement because it hurts too much, and they are terrifi ed they will damage something. “Another thing that predicts whether someone goes on to chronic pain is an absolute search for a passive answer, whereas we know that those who seek an active answer, which might mean knowledge or exercise, will do better. And the fourth thing that always predicts whether someone goes on to chronic pain is a withdrawal from social life. They decide to stay home, to retreat.”


And he says scary medical diagnoses can in themselves create changes in the brain – for example, in the diagnosis of “slipped disc”. In reality, says Butler, there is no such thing as a slipped disc, as the discs in the spine are firmly held in place. What they are is bulging discs. “If you’re told that you’ve got a slipped disc and that the x-ray shows degeneration, but you aren’t told that this is very common, that 70% of people have bulging discs, and that 90% of people have degeneration in their back, then that would be another reason that the brain would change. There would be more fear; it would increase the belief that pain equals damage; it would give you more fear avoidance; and you would say, ‘I’m not going out tonight, I’m staying home.’”


Butler’s recipe for recovery from pain is to accept that in many cases pain is normal, to get moving, to be social and to seek active answers. Pleasure is also part of the answer. “When the brain lights up and feels pleasure, it’s not much different than pain. When you’re having pleasure, you’re exercising the bits of your brain related to pain. The more pleasure you have, the less pain you’ll have.” For Ng, life is now blessedly more ordinary. He has been able to continue his studies, and is due to finish his law degree this year. “I can do so much more. Everything’s more normal.”


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Back pain relief with graded motor imagery is practiced by many physiotherapists. It has been found to be an effective treatment for many patients. This relief technique works in a dramatic way for some people suffering from back pain and not for others. It depends on the quality of the treatment and dedication of the physiotherapist to get effective treatment for the long-term relief of back pain. As there are various kinds of new and unorthodox treatments available for back pain, trying them has become popular with many patients at their wits end. However, the patient will most likely have a period of trial and error to find out which treatment is most effective for their circumstances.


In this video David Butler explains mirror therapy. He discusses neuroscience, mirror box techniques and related therapy.





Here David Butler gives a 40 minute presentation on Graded Motor Imagery.





To assess other more unorthodox techniques to relieve back pain, as well as the more accepted treatments, check out the free 7 Day Back Pain Cure book we are giving away on our website. You can sign up below to receive it.




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