EFFECT OF GRADED MOTOR IMAGERY ON PHANTOM LIMB PAIN IN AMPUTEES: A NARRATIVE REVIEW

Abstract

Background: Phantom limb pain (PLP) is a common and potentially disabling consequence of limb amputation. Although its pathophysiology is multifactorial and may involve peripheral neural changes, cortical reorganization, and altered sensorimotor processing. Graded motor imagery (GMI) is a non-invasive rehabilitation approach comprising laterality recognition, explicit motor imagery, and mirror therapy. Objective: To review the available evidence regarding the effectiveness of graded motor imagery in reducing phantom limb pain in individuals with limb amputation. Methodology: A narrative review was conducted using the full-text studies identified for the review. Studies investigating GMI and related interventions were examined. Data related to study design, sample size, intervention, comparator, outcome measures, and findings were extracted. The methodological quality of applicable RCTs was assessed using PEDro Scale, and the level of evidence was classified according to the Modified Sackett Level of Evidence, Version 4.0. Due to heterogeneity among studies, findings were synthesized narratively. Result: The strongest direct evidence was provided by Limakatso et al. that a six-week GMI programme produced significantly greater improvements in pain severity than routine physiotherapy. Pain interference was significantly improved in the GMI group, whereas health-related quality of life did not differ between groups. Supporting studies investigating mental imagery, phantom exercises, and mirror therapy generally reported improvements in PLP. Conclusion: GMI is a promising non-pharmacological intervention for PLP. The available direct evidence supports reductions in pain, but the evidence base remains limited by small samples and methodological heterogeneity. Keywords: phantom limb pain; amputation; graded motor imagery; mental imagery; mirror therapy