Expose or protect? A randomized controlled trial of exposure in vivo vs pain-contingent treatment as usual in patients with complex regional pain syndrome type 1

Marlies den Hollander, Mariëlle Goossens, Jeroen de Jong, Joop Ruijgrok, Jan Oosterhof, Patrick Onghena, Rob Smeets, Johan W S Vlaeyen

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)

Abstract

Complex regional pain syndrome type I (CRPS-I) highly affects patients' ability to perform daily life activities. Pain-related fear might be a key target to reduce disability in chronic pain. Current treatments aiming at reducing pain show little improvements on pain and disability, whereas novel exposure-based treatments targeting pain-related fears have shown to be promising. We conducted a randomized controlled trial (N = 46) comparing exposure in vivo (EXP) with pain-contingent treatment as usual (TAU), for CRPS-I patients with at least moderate levels of pain-related fear. Primary outcome is self-reported disability, for upper and lower extremity, respectively. Secondary outcomes are self-reported pain-intensity, pain-catastrophizing, perceived harmfulness of physical activity, and health-related quality of life. Pretreatment to posttreatment and pretreatment to 6-month follow-up change scores were tested using randomization-based inference. EXP was superior to TAU in reducing upper extremity disability from pretreatment to posttreatment (between-group difference, 1.082; 95% confidence interval [CI], 0.563-1.601; P < 0.001) and from pretreatment to 6-month follow-up (1.303; 95% CI, 0.917-1.690; P < 0.001). EXP was superior in reducing lower extremity disability from pretreatment to 6-month follow-up (3.624; 95% CI, 0.467-6.781; P = 0.02), but not from pretreatment to posttreatment (3.055; 95% CI, -0.018 to 6.128; P = 0.054). All secondary outcomes significantly favored EXP pretreatment to posttreatment, as well as pretreatment to 6-month follow-up. Exposure to daily activities shows to be more effective than a protective pain-contingent TAU in reducing self-reported disability in daily life of CRPS-I patients with at least moderate levels of pain-related fear.

Original languageEnglish
Pages (from-to)2318–2329
Number of pages12
JournalPain
Volume157
Issue number10
DOIs
Publication statusPublished - Oct 2016

Keywords

  • Pain-related fear
  • Avoidance
  • CRPS-I
  • Exposure in vivo
  • Cognitive-behavioral treatment
  • LOW-BACK-PAIN
  • CHRONIC MUSCULOSKELETAL PAIN
  • ADJUVANT PHYSICAL-THERAPY
  • FEAR-AVOIDANCE MODEL
  • NEUROPATHIC PAIN
  • FUNCTIONAL LIMITATIONS
  • PERCEIVED HARMFULNESS
  • NECK PAIN
  • REDUCTION
  • SCALE

Cite this

@article{56be5c2d00804e83a2ceb77f7a6317e3,
title = "Expose or protect?: A randomized controlled trial of exposure in vivo vs pain-contingent treatment as usual in patients with complex regional pain syndrome type 1",
abstract = "Complex regional pain syndrome type I (CRPS-I) highly affects patients' ability to perform daily life activities. Pain-related fear might be a key target to reduce disability in chronic pain. Current treatments aiming at reducing pain show little improvements on pain and disability, whereas novel exposure-based treatments targeting pain-related fears have shown to be promising. We conducted a randomized controlled trial (N = 46) comparing exposure in vivo (EXP) with pain-contingent treatment as usual (TAU), for CRPS-I patients with at least moderate levels of pain-related fear. Primary outcome is self-reported disability, for upper and lower extremity, respectively. Secondary outcomes are self-reported pain-intensity, pain-catastrophizing, perceived harmfulness of physical activity, and health-related quality of life. Pretreatment to posttreatment and pretreatment to 6-month follow-up change scores were tested using randomization-based inference. EXP was superior to TAU in reducing upper extremity disability from pretreatment to posttreatment (between-group difference, 1.082; 95{\%} confidence interval [CI], 0.563-1.601; P < 0.001) and from pretreatment to 6-month follow-up (1.303; 95{\%} CI, 0.917-1.690; P < 0.001). EXP was superior in reducing lower extremity disability from pretreatment to 6-month follow-up (3.624; 95{\%} CI, 0.467-6.781; P = 0.02), but not from pretreatment to posttreatment (3.055; 95{\%} CI, -0.018 to 6.128; P = 0.054). All secondary outcomes significantly favored EXP pretreatment to posttreatment, as well as pretreatment to 6-month follow-up. Exposure to daily activities shows to be more effective than a protective pain-contingent TAU in reducing self-reported disability in daily life of CRPS-I patients with at least moderate levels of pain-related fear.",
keywords = "Pain-related fear, Avoidance, CRPS-I, Exposure in vivo, Cognitive-behavioral treatment, LOW-BACK-PAIN, CHRONIC MUSCULOSKELETAL PAIN, ADJUVANT PHYSICAL-THERAPY, FEAR-AVOIDANCE MODEL, NEUROPATHIC PAIN, FUNCTIONAL LIMITATIONS, PERCEIVED HARMFULNESS, NECK PAIN, REDUCTION, SCALE",
author = "{den Hollander}, Marlies and Mari{\"e}lle Goossens and {de Jong}, Jeroen and Joop Ruijgrok and Jan Oosterhof and Patrick Onghena and Rob Smeets and Vlaeyen, {Johan W S}",
year = "2016",
month = "10",
doi = "10.1097/j.pain.0000000000000651",
language = "English",
volume = "157",
pages = "2318–2329",
journal = "Pain",
issn = "0304-3959",
publisher = "LIPPINCOTT WILLIAMS & WILKINS",
number = "10",

}

Expose or protect? A randomized controlled trial of exposure in vivo vs pain-contingent treatment as usual in patients with complex regional pain syndrome type 1. / den Hollander, Marlies; Goossens, Mariëlle; de Jong, Jeroen; Ruijgrok, Joop; Oosterhof, Jan; Onghena, Patrick; Smeets, Rob; Vlaeyen, Johan W S.

In: Pain, Vol. 157, No. 10, 10.2016, p. 2318–2329.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Expose or protect?

T2 - A randomized controlled trial of exposure in vivo vs pain-contingent treatment as usual in patients with complex regional pain syndrome type 1

AU - den Hollander, Marlies

AU - Goossens, Mariëlle

AU - de Jong, Jeroen

AU - Ruijgrok, Joop

AU - Oosterhof, Jan

AU - Onghena, Patrick

AU - Smeets, Rob

AU - Vlaeyen, Johan W S

PY - 2016/10

Y1 - 2016/10

N2 - Complex regional pain syndrome type I (CRPS-I) highly affects patients' ability to perform daily life activities. Pain-related fear might be a key target to reduce disability in chronic pain. Current treatments aiming at reducing pain show little improvements on pain and disability, whereas novel exposure-based treatments targeting pain-related fears have shown to be promising. We conducted a randomized controlled trial (N = 46) comparing exposure in vivo (EXP) with pain-contingent treatment as usual (TAU), for CRPS-I patients with at least moderate levels of pain-related fear. Primary outcome is self-reported disability, for upper and lower extremity, respectively. Secondary outcomes are self-reported pain-intensity, pain-catastrophizing, perceived harmfulness of physical activity, and health-related quality of life. Pretreatment to posttreatment and pretreatment to 6-month follow-up change scores were tested using randomization-based inference. EXP was superior to TAU in reducing upper extremity disability from pretreatment to posttreatment (between-group difference, 1.082; 95% confidence interval [CI], 0.563-1.601; P < 0.001) and from pretreatment to 6-month follow-up (1.303; 95% CI, 0.917-1.690; P < 0.001). EXP was superior in reducing lower extremity disability from pretreatment to 6-month follow-up (3.624; 95% CI, 0.467-6.781; P = 0.02), but not from pretreatment to posttreatment (3.055; 95% CI, -0.018 to 6.128; P = 0.054). All secondary outcomes significantly favored EXP pretreatment to posttreatment, as well as pretreatment to 6-month follow-up. Exposure to daily activities shows to be more effective than a protective pain-contingent TAU in reducing self-reported disability in daily life of CRPS-I patients with at least moderate levels of pain-related fear.

AB - Complex regional pain syndrome type I (CRPS-I) highly affects patients' ability to perform daily life activities. Pain-related fear might be a key target to reduce disability in chronic pain. Current treatments aiming at reducing pain show little improvements on pain and disability, whereas novel exposure-based treatments targeting pain-related fears have shown to be promising. We conducted a randomized controlled trial (N = 46) comparing exposure in vivo (EXP) with pain-contingent treatment as usual (TAU), for CRPS-I patients with at least moderate levels of pain-related fear. Primary outcome is self-reported disability, for upper and lower extremity, respectively. Secondary outcomes are self-reported pain-intensity, pain-catastrophizing, perceived harmfulness of physical activity, and health-related quality of life. Pretreatment to posttreatment and pretreatment to 6-month follow-up change scores were tested using randomization-based inference. EXP was superior to TAU in reducing upper extremity disability from pretreatment to posttreatment (between-group difference, 1.082; 95% confidence interval [CI], 0.563-1.601; P < 0.001) and from pretreatment to 6-month follow-up (1.303; 95% CI, 0.917-1.690; P < 0.001). EXP was superior in reducing lower extremity disability from pretreatment to 6-month follow-up (3.624; 95% CI, 0.467-6.781; P = 0.02), but not from pretreatment to posttreatment (3.055; 95% CI, -0.018 to 6.128; P = 0.054). All secondary outcomes significantly favored EXP pretreatment to posttreatment, as well as pretreatment to 6-month follow-up. Exposure to daily activities shows to be more effective than a protective pain-contingent TAU in reducing self-reported disability in daily life of CRPS-I patients with at least moderate levels of pain-related fear.

KW - Pain-related fear

KW - Avoidance

KW - CRPS-I

KW - Exposure in vivo

KW - Cognitive-behavioral treatment

KW - LOW-BACK-PAIN

KW - CHRONIC MUSCULOSKELETAL PAIN

KW - ADJUVANT PHYSICAL-THERAPY

KW - FEAR-AVOIDANCE MODEL

KW - NEUROPATHIC PAIN

KW - FUNCTIONAL LIMITATIONS

KW - PERCEIVED HARMFULNESS

KW - NECK PAIN

KW - REDUCTION

KW - SCALE

U2 - 10.1097/j.pain.0000000000000651

DO - 10.1097/j.pain.0000000000000651

M3 - Article

C2 - 27429174

VL - 157

SP - 2318

EP - 2329

JO - Pain

JF - Pain

SN - 0304-3959

IS - 10

ER -