New information regarding cortical changes in patients with chronic pain has prompted a reevaluation of the typical "bottom up" treatment for pain, which focuses on peripheral nociceptive stimuli. More recently, increasing considerations for chronic pain are focused from the "top down" cortical central processing perspective. Graded motor imagery (GMI) is one treatment technique from the "top down" paradigm designed to treat chronic pain. This technique attempts to sequentially normalize central processing to remediate chronic pain. This article briefly summarizes the basic components of GMI, targeting complex regional pain in the upper limb, and describes a case where this method was successfully integrated. The initial research and clinical experience is promising and indicates that patients with chronic pain may benefit from using GMI to "retrain the brain."
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