Treatment of a Patient With Central Pain Sensitization Using Graded Motor Imagery Principles: A Case Report

Abstract

OBJECTIVE: This case report describes the application of graded motor imagery principles to a patient experiencing central sensitization and chronic pain. CLINICAL FEATURES: A 46-year-old woman presented with pain in all 4 limbs along with global spinal pain and loss of range of motion. These symptoms initiated after a motor vehicle accident 5 years before and were exacerbated by 2 subsequent motor vehicle accidents. Examination indicated global loss of spinal range of motion, severe apprehension toward any movement, decreased grip strength bilaterally, and loss of 2-point discrimination. A variety of outcome assessments indicated severe disability. INTERVENTION AND OUTCOME: The patient was seen at the chiropractic clinic 5× over 6 weeks and showed marked improvement with each visit. Treatment included pain neuroscience education, laterality training using the Recognize app, and explicit motor imagery. The patient demonstrated improvement in all baseline measures just described, including outcome assessment scores. CONCLUSIONS: Over time, the patient reported decreased chronic pain and disability, along with improvement in grip strength and range of motion, after application of graded motor imagery strategies.