GMI + Mirror Therapy Evidences:

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• Goal: Both GMI and MT aim to correct distorted cortical representation and reduce sensorimotor incongruence in CRPS and chronic upper-limb pain.

• Early Evidence: Moseley’s early studies suggested meaningful pain and disability reductions.

• Updated Evidence: Newer, higher-quality trials show inconsistent and modest clinical effects.

• Cochrane 2022 (Smart et al.): GMI and MT rated low to very-low certainty due to small sample sizes, heterogeneity, and poor replication.

• Recent RCTs: MT may give short-term pain relief or improved laterality, but often no better than sham or active control, and improvements rarely persist.

• Neuroimaging: Both GMI and MT can temporarily change somatosensory/motor cortex activity, but these do not reliably translate to lasting functional improvements.

• Overall Conclusion: GMI and MT are adjunctive tools, offering short-term sensory– cognitive modulation, but not sufficient as primary treatments for CRPS.

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References:

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1. Smart KM, Blake C, Staines A, Doody C.

Physiotherapy management of complex regional pain syndrome.

Cochrane Database Syst Rev. 2022;5:CD010853.
Key finding: GMI and MT rated as low to very-low certainty, with inconsistent pain improvements and uncertain functional benefit.

2. Harvie DS, Broecker M, Smith RT, et al.

Lack of supportive evidence for Graded Motor Imagery in chronic pain: a systematic review and evidence update.
Pain Reports. 2023;8(1):e1031.
Key finding: Across conditions including CRPS, GMI effects are inconsistent and generally small; no robust RCTs showing long-term benefit.

3. Sella F, Bolognini N, Russo C, et al.Neurophysiological effects of mirror therapy on cortical organization in complex regional pain syndrome.
Neurology. 2022;98(10):e1024–e1034.
Key finding: Mirror therapy alters cortical excitability temporarily, but clinical improvements in pain and function were not sustained.

4. Martínez-López EJ, de Miguel-Valtierra L, Palomo-López P, et al.

Effectiveness of mirror therapy in upper-limb pain syndromes: an updated systematic review.
J Hand Ther. 2023;36(2):251-263.
Key finding: MT shows short-term pain reduction, but evidence quality is low, long-term benefits unclear, and heterogeneity remains high.

5. Hebert JJ, Olver M, Gabel CP.

Laterality training and motor imagery for chronic upper limb pain: randomized controlled trial.
Clin J Pain. 2024;40(3):187-196.
Key finding: Laterality + motor imagery improved mental rotation accuracy but yielded no superior pain reductioncompared with control therapy.