Movement imagery increases pain in people with neuropathic pain following complete thoracic spinal cord injury

Gustin, Sylvia M.; Wrigley, Paul J.; Gandevia, Simon C.; Middleton, James W.; Henderson, Luke A.; Siddall, Philip J.

doi:10.1016/j.pain.2007.08.032

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Volume 137, Issue 2 , Pages 237-244, 15 July 2008

Movement imagery increases pain in people with neuropathic pain following complete thoracic spinal cord injury

Sylvia M. Gustin
- Department of Anatomy and Histology, F13, The University of Sydney, Sydney, NSW 2006, Australia
- Pain Management Research Institute, The University of Sydney, Royal North Shore Hospital, Sydney, NSW 2065, Australia
Paul J. Wrigley
- Pain Management Research Institute, The University of Sydney, Royal North Shore Hospital, Sydney, NSW 2065, Australia
Simon C. Gandevia
- Prince of Wales Medical Research Institute, Sydney, NSW 2031, Australia
James W. Middleton
- Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Sydney, NSW 2065, Australia
Luke A. Henderson
- Department of Anatomy and Histology, F13, The University of Sydney, Sydney, NSW 2006, Australia
- Corresponding author. Tel.: +61 2 9351 7063; fax: +61 2 9351 6556.
Philip J. Siddall
- Pain Management Research Institute, The University of Sydney, Royal North Shore Hospital, Sydney, NSW 2065, Australia

Received 7 May 2007; received in revised form 14 August 2007; accepted 23 August 2007. published online 17 October 2007.

Abstract

Spinal cord injury (SCI) results in deafferentation and the onset of neuropathic pain in a substantial proportion of people. Based on evidence suggesting motor cortex activation results in attenuation of neuropathic pain, we sought to determine whether neuropathic SCI pain could be modified by imagined movements of the foot. Fifteen subjects with a complete thoracic SCI (7 with below-level neuropathic pain and 8 without pain) were instructed in the use of movement imagery. Movement imagery was practiced three times daily for 7days. On the eighth day, subjects performed the movement imagery in the laboratory and recorded pain ratings during the period of imagined movement. Six out of 7 subjects with neuropathic pain reported an increase in pain during imagined movements from 2.9±0.7 during baseline to 5.0±1.0 during movement imagery (p<0.01). In SCI subjects without neuropathic pain, movement imagery evoked an increase in non-painful sensation intensity from a baseline of 1.9±0.7 to 4.8±1.3 during the movement imagery (p<0.01). Two subjects without a history of pain or non-painful phantom sensations had onset of dysesthesia while performing imagined movements. This study reports exacerbation of pain in response to imagined movements and it contrasts with reports of pain reduction in people with peripheral neuropathic pain. The potential mechanisms underlying this sensory enhancement with movement imagery are discussed.