• S Johnson, J Hall, S Barnett, M Draper, G Derbyshire, L Haynes, C Rooney, H Cameron, G L Moseley, de C Williams A C AC, C McCabe, and A Goebel.
• The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK.
• Eur J Pain. 2012 Apr 1; 16 (4): 550-61.

BackgroundThere is good evidence from studies conducted in a single-centre research setting for the efficacy of graded motor imagery (GMI) treatment, a complex physiotherapy intervention, to reduce pain in long-standing complex regional pain syndrome (CRPS). However, whether GMI is effective in clinical practice is not established.AimTo establish whether GMI is effective in clinical practice.MethodsWe undertook a prospective audit of GMI treatment at two UK centres with a special interest in the management of patients with CRPS. All patients received GMI, in conjunction with a range of other 'best practice' physical and psychological interventions.ResultsThe patients' average pain intensities did not improve with treatment [centre 1: n = 20, pre-post numeric rating scale (NRS) difference 0.6 [confidence interval (CI) -0.3 to 1.5]; centre 2: n = 12, pre-post NRS difference 0.2 (CI: -0.9 to 1.2)]. Patients at centre 1 reported significant functional improvement. Improved performance on left/right judgement replicated in both centres seen in the clinical trials.ConclusionsThe failure of our real-world implementation of GMI suggests that better understanding of both the GMI methodology and its interaction with other treatment methods is required to ensure that GMI research results can be translated into clinical practice. Our results highlight challenges with the translation of complex interventions for chronic pain conditions into clinical practice.© 2011 European Federation of International Association for the Study of Pain Chapters.

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