Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. X:X | DOI: 10.5507/bp.2025.034

Effectiveness of motor imagery techniques in the treatment of chronic musculoskeletal pain: A scoping review

Petr Kolar1, 2, Marketa Kovarova1, 2, Barbora Kolarova1, 2, Miroslav Haltmar3, Martin Jochec3, Petr Hlustik3
1 Department of Rehabilitation, University Hospital Olomouc, Olomouc, Czech Republic
2 Department of Clinical Rehabilitation, Faculty of Health Sciences, Palacky University Olomouc, Olomouc, Czech Republic
3 Department of Neurology, Palacky University Olomouc, Olomouc, Czech Republic

Recent neurophysiological studies provide evidence that motor imagery techniques, as a non-pharmacological intervention, reduce the perception of pain intensity at the cortical level and can therefore be used in clinical practice in patients with chronic musculoskeletal pain (CMP). The aim of this scoping review was to evaluate recent randomised controlled trials on the effect of motor imagery techniques for the relief of CMP.

Four databases (PubMed, Scopus, Proquest, Cochrane Clinical Trials) were searched to identify randomised controlled trials on the effect of motor imagery techniques on the subjective intensity of musculoskeletal pain lasting for > 3 months in adults. Ten trials (349 participants) were identified for inclusion in this scoping review conducted following the PRISMA-ScR guidelines.

The majority of the included studies showed that the motor imagery techniques reduced pain intensity in patients with CMP (namely in patients with post-traumatic phantom limb pain, adhesive capsulitis, impingement syndrome and non‑specific neck pain). immediately after therapeutic sessions, compared with control groups, and also in follow-up measurements up to a few months after baseline measurement. The motor imagery techniques used in the therapeutic sessions lasted more than four weeks, with at least three sessions of at least ten minutes each performed per week. The main limitations were the lack of high‑quality, double‑blind evidence with sufficient numbers of participants.

This review summarises randomised controlled trials and shows that motor imagery techniques have considerable potential for the relief of CMP. High-quality evidence is needed to further support the use of motor imagery in clinical practice.

Keywords: chronic pain, musculoskeletal, motor imagery, mirror therapy

Received: June 23, 2025; Revised: November 11, 2025; Accepted: December 10, 2025; Prepublished online: January 6, 2026 

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    References

    1. Opavský J. Specifika a rozdíly ve vyšetřování a v přístupu k pacientům s akutní nebo chronickou bolestí (Specifics and differences in the investigation and approach to patients with acute or chronic pain). Med pro praxi 2010;7(2):76-9. (In Czech)
    2. Walters ET, Williams ACC. Evolution of mechanisms and behaviour important for pain. Philos Trans R Soc Lond B Biol Sci 2019;374:20190275. Go to original source...
    3. Kec D, Bednařík J, Ludka O, Hamerníková V, Vlčková E. Treatment of insomnia in neuropathic pain. Cesk Slov Neurol N 2019;82(5):513-17. Go to original source...
    4. Smith E, Hoy DG, Cross M, Vos T, Naghavi M, Buchbinder R, Woolf AD, March L. The global burden of other musculoskeletal disorders: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014;73:1462-9. Go to original source...
    5. Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG. Lancet Low Back Pain Series Working Group. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet 2018;391(10137):2368-83. Go to original source...
    6. MacIver K, Lloyd DM, Kelly S, Roberts N, Nurmikko T. Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery. Brain 2008;131(Pt 8):2181-91. Go to original source...
    7. Kim W, Kim SK, Nabekura J. Functional and structural plasticity in the primary somatosensory cortex associated with chronic pain. J Neurochem 2017;141(4):499-506. Go to original source...
    8. Apkarian AV, Bushnell MC, Treede RD, Zubieta JK. Human brain mechanisms of pain perception and regulation inhealth and disease. Eur J Pain 2005;9(4):463-84. Go to original source...
    9. Pelletier R, Higgins J, Bourbonnais D. Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders? BMC Musculoskelet Disord 2015;16:25. Go to original source...
    10. Malfliet A, Coppieters I, Van Wilgen P, Kregel J, De Pauw R, Dolphens M, Ickmans K. Brain changes associated with cognitive and emotional factors in chronic pain: A systematic review. Eur J Pain 2017;21(5):769-86. Go to original source...
    11. Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumer N, Larbig W, Taub E. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 1995;375(6531):482-4. Go to original source...
    12. Maihöfner C, Handwerker HO, Neundörfer B, Birklein F. Patterns of cortical reorganization in complex regional pain syndrome. Neurology 2003;61(12):1707-15. Go to original source...
    13. Seifert F, Maihöfner C. Central mechanisms of experimental and chronic neuropathic pain: findings from functional imaging studies. Cell Mol Life Sci 2009;66(3):375-90. Go to original source...
    14. Vierck CJ, Whitsel BL, Favorov OV, Brown AW, Tommerdahl M. Role of primary somatosensory cortex in the coding of pain. Pain 2013;154(3):334-44. Go to original source...
    15. Le Pera D, Graven-Nielsen T, Valeriani M, Oliviero A, Di Lazzaro V, Tonali PA, Arendt-Nielsen L. Inhibition of motor system excitability at cortical and spinal level by tonic muscle pain. Clin Neurophysiol 2001;112(9):1633‑41. Go to original source...
    16. Deconinck FJ, Smorenburg AR, Benham A, Ledebt A, Feltham MG, Savelsbergh GJ. Reflections on mirror therapy: a systematic review of the effect of mirror visual feedback on the brain. Neurorehabil Neural Repair 2015;29(4):349-61. Go to original source...
    17. Pons TP, Garraghty PE, Ommaya AK, Kaas JH, Taub E, Mishkin M. Massive cortical reorganization after sensory deafferentation in adult macaques. Science 1991;252(5014):1857-60. Go to original source...
    18. Mulder T. Motor imagery and action observation: cognitive tools for rehabilitation. J Neural Transm (Vienna) 2007;114(10):1265-78. Go to original source...
    19. Nicholson VP, Keogh JWL, Low Choy NL. Can a single session of motor imagery promote motor learning of locomotion in older adults? A randomized controlled trial. Clin Interv Aging 2018;13:713-22. Go to original source...
    20. Acharya S, Shukla S. Mirror neurons: Enigma of the metaphysical modular brain. J Nat Sci Biol Med 2012;3(2):118-24. Go to original source...
    21. Buccino G. Action observation treatment: a novel tool in neurorehabilitation. Philos Trans R Soc Lond B Biol Sci 2014;369(1644):20130185. Go to original source...
    22. Jeannerod M. Neural simulation of action: a unifying mechanism for motor cognition. Neuroimage 2001;14(1 Pt 2):S103-9. Go to original source...
    23. Kilner JM, Lemon RN. What we know currently about mirror neurons. Curr Biol 2013;23(23):R1057-62. Go to original source...
    24. Lotze M, Montoya P, Erb M, Hülsmann E, Flor H, Klose U, Birbaumer N, Grodd W. Activation of cortical and cerebellar motor areas during executed and imagined hand movements: an fMRI study. J Cogn Neurosci 1999;11(5):491-501. Go to original source...
    25. Lotze M, Braun C, Birbaumer N, Anders S, Cohen LG. Motor learning elicited by voluntary drive. Brain 2003;126(Pt 4):866-72. Go to original source...
    26. Solodkin A, Hlustik P, Chen EE, Small SL. Fine modulation in network activation during motor execution and motor imagery. Cereb Cortex 2004;14(11):1246-55. Go to original source...
    27. Moseley GL. Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial. Pain 2004;108(1-2):192-8. Go to original source...
    28. Moseley GL. Graded motor imagery for pathologic pain: a randomized controlled trial. Neurology 2006;67(12):2129-34. Go to original source...
    29. Ramachandran VS, Rogers-Ramachandran D, Cobb S. Touching the phantom limb. Nature 1995;377(6549):489-90. Go to original source...
    30. Wittkopf PG, Johnson MI. Mirror therapy. A potential intervention for pain management. Rev Assoc Med Bras (1992) 2017;63(11):1000-05. Go to original source...
    31. Anaforoğlu Külünkoğlu B, Erbahçeci F, Alkan A. A comparison of the effects of mirror therapy and phantom exercises on phantom limb pain. Turk J Med Sci 2019;49(1):101-09.
    32. Başkaya MÇ, Erçalik C, Karataş Kir Ö, Erçalik T, Tuncer T. The efficacy of mirror therapy in patients with adhesive capsulitis: A randomized, prospective, controlled study. J Back Musculoskelet Rehabil 2018;31(6):1177-82. Go to original source...
    33. Finn SB, Perry BN, Clasing JE, Walters LS, Jarzombek SL, Curran S, Rouhanian M, Keszler MS, Hussey-Andersen LK, Weeks SR, Pasquina PF, Tsao JW. A Randomized, Controlled Trial of Mirror Therapy for Upper Extremity Phantom Limb Pain in Male Amputees. Front Neurol 2017;8:267. Go to original source...
    34. Hoyek N, Di Rienzo F, Collet C, Hoyek F, Guillot A. The therapeutic role of motor imagery on the functional rehabilitation of a stage II shoulder impingement syndrome. Disabil Rehabil 2014;36(13):1113-9. Go to original source...
    35. Javdaneh N, Molayei F, Kamranifraz N. Effect of adding motor imagery training to neck stabilization exercises on pain, disability and kinesiophobia in patients with chronic neck pain. Complement Ther Clin Pract 2021;42:101263. Go to original source...
    36. Limakatso K, Madden VJ, Manie S, Parker R. The effectiveness of graded motor imagery for reducing phantom limb pain in amputees: a randomised controlled trial. Physiotherapy 2020;109:65-74. Go to original source...
    37. Mena-Del Horno S, Balasch-Bernat M, Louw A, Luque-Suarez A, Rodríguez-Brazzarola P, Navarro-Ledesma S, Murillo C, Dueñas L, Lluch E. Is there any benefit of adding a central nervous system-focused intervention to a manual therapy and home stretching program for people with frozen shoulder? A randomized controlled trial. J Shoulder Elbow Surg 202;32(7):1401-11. Go to original source...
    38. Ol HS, Van Heng Y, Danielsson L, Husum H. Mirror therapy for phantom limb and stump pain: a randomized controlled clinical trial in landmine amputees in Cambodia. Scand J Pain 2018;18(4):603-10. Go to original source...
    39. Özcan Ö, Kul Karaali H, Ilgin D, Algun ZC. Effectiveness of motor imagery training on functionality and quality of life in chronic neck pain: a randomized controlled trial. J Exerc Ther Rehabil 2019;6(1):01-09.
    40. Öztürk Ö, Bombaci H, Keçeci T, Algun ZC. Effects of additional action observation to an exercise program in patients with chronic pain due to knee osteoarthritis: A randomized-controlled trial. Musculoskelet Sci Pract 2021;52:102334. Go to original source...
    41. Cohen H, McCabe C, Harris N, Hall J, Lewis J, Blake DR. Clinical evidence of parietal cortex dysfunction and correlation with extent of allodynia in CRPS type 1. Eur J Pain 2013;17(4):527-38. Go to original source...
    42. Förderreuther S, Sailer U, Straube A. Impaired self-perception of the hand in complex regional pain syndrome (CRPS). Pain 2004;110(3):756-61. Go to original source...
    43. Mercier C, Léonard G. Interactions between Pain and the Motor Cortex: Insights from Research on Phantom Limb Pain and Complex Regional Pain Syndrome. Physiother Can 2011;63(3):305-14. Go to original source...
    44. Binkofski F, Amunts K, Stephan KM, Posse S, Schormann T, Freund HJ, Zilles K, Seitz RJ. Broca's region subserves imagery of motion: a combined cytoarchitectonic and fMRI study. Hum Brain Mapp 2000;11(4):273-85. Go to original source...
    45. Decety J. The neurophysiological basis of motor imagery. Behav Brain Res 1996;77(1-2):45-52. Go to original source...
    46. Guillot A, Collet C, Nguyen VA, Malouin F, Richards C, Doyon J. Brain activity during visual versus kinesthetic imagery: an fMRI study. Hum Brain Mapp 2009;30(7):2157-72. Go to original source...
    47. Lotze M, Flor H, Grodd W, Yau JM. Phantom movements and pain. An fMRI study in upper limb amputees. Brain 2001;124(Pt 11):2268-77. Go to original source...
    48. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:l4898. doi: 10.1136/bmj.l4898 Go to original source... Go to PubMed...
    49. Suso-Martí L, La Touche R, Angulo-Díaz-Parreño S, Cuenca-Martínez F. Effectiveness of motor imagery and action observation training on musculoskeletal pain intensity: A systematic review and meta-analysis. Eur J Pain 2020;24(5):886-901. doi: 10.1002/ejp.1540 Go to original source... Go to PubMed...
    50. Yap BWD, Lim ECW. The effects of motor imagery on pain and range of motion in musculoskeletal disorders: A systematic review using meta-analysis. Clin J Pain 2019;35(1):87-99. doi: 10.1097/AJP.0000000000000648 Go to original source... Go to PubMed...
    51. Alaca N, Acar AÖ, Öztürk S. Effectiveness of movement representation techniques in non-specific shoulder pain: A systematic review and meta-analysis. Sci Rep 2025;15:205. doi: 10.1038/s41598-024-84016-9 Go to original source... Go to PubMed...

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