I am not currently working in a pain centre, however I was previously. I spent a great deal of time and effort attempting to get a graded motor imagery programme off the ground for people with CRPS and I’m still quite passionate about it.
What Peter has described above was a factor for all of the patients I can recall that I worked with using the GMI approach. They would describe not being able to “see” the limb from the approximate point where other symptoms were apparent. I wondered about a link between the lack of activity in the somatosensory cortex re. the affected limb as seen on fMRI and this experience that people reported. The more “chronic” patients seemed to need quite some time spent on comparing the pictures in the limb laterality exercises to their own limbs in order to be able to begin to make choices about whether a left or right limb was represented. I could only guess that this was due to their inability to “access” the “invisible” part of the limb.

Found an intersesting, to me new “phenomena” while working , starting up GMI on a patient with pathologic pain in her left arm, hand(my conclusion).

Coming to step 2, look at images try to imagine movements, positions, patient reported no pain but also an intersting point. While closing her eyes imagining movements with her healthy arm, hand she could visualise her arm. Trying to do the same thing with her affected side she couldn´t visualise that arm, hand for her “inner eye. “It´s just a black spot”.

I don´t know if you have to be able to “see” your affected bodypart for your “inner eye” to activate pre motor, motor cortices or if it is enough just to give the mental comand to move that part. My guess is that you don´t have to “see”, but of course I don´t know.

Can´t help but wondering…if that diffrence, not beeing able to “see” that side, could be a sign of even more “programelocks”-protective responses? or possible an inner sign of imobilisation-cortical distortions? Is she not “allowed” to activate motor cortises this way=no pain?

She can move her arm, hand but hardly won´t because of severe, longstanding elevated painlevel.

All the best…
Peter/PT/Sweden