• Luis Suso-Martí, Roy La Touche, Santiago Angulo-Díaz-Parreño, and Ferran Cuenca-Martínez.
• Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.
• Eur J Pain. 2020 May 1; 24 (5): 886-901.

Background And ObjectiveMovement representation techniques such as motor imagery (MI) and action observation (AO) could play an important role in the field of rehabilitation of patients with musculoskeletal pain; however, the effects of these tools on clinical pain remain unclear. Our objective is therefore to develop a systematic review and meta-analysis of the effects of MI and AO regarding the pain intensity on patients with musculoskeletal pain.Databases And Data TreatmentMEDLINE, EMBASE, CINAHL and Google Scholar were searched. Last search was run on July 2019. Meta-analysis was conducted to determine the effectiveness on pain intensity in patients with post-surgical pain or chronic pain, and GRADE was used to rate the quality, certainty and applicability of the evidence.ResultsA total of 10 studies were included. AO or MI were compared versus usual rehabilitation care. The meta-analysis showed statistically significant differences in MI and AO interventions in patients with pain after surgery in six studies, with a large clinical effect (n = 124; SMD = -0.84; 95% CI: -1.47 to -0.21). In patients with chronic pain, results showed statistically significant differences in MI and AO interventions in three studies, with a large clinical effect (n = 83; SMD = -2.14; 95% CI: -3.81 to -0.47). Risk of bias, imprecision and inconsistency decreased the GRADE level of evidence.ConclusionsThere was very low-quality evidence regarding the effects of movement representation techniques intervention (AO and MI) on pain intensity in patients with post-surgical pain. In addition, there was very low-quality evidence regarding the effects of MI and AO interventions on chronic pain.SignificanceMovement representation techniques in combination with usual care are capable of producing a decrease in pain intensity compared with conventional treatment, in both post-surgical and chronic pain. However, the very low-quality evidence found regarding these techniques showed that more research is needed for their application in a clinical context.© 2020 European Pain Federation - EFIC®.

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