Pain-related fear, perceived harmfulness of activities, and functional limitations in complex regional pain syndrome type I

J.R. de Jong, J.W.S. Vlaeyen, J.M. de Gelder, J. Patijn

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Numerous studies have shown that pain-related fear is one of the strongest predictors of pain disability in patients with chronic musculoskeletal pain, and there is evidence that the reduction of pain-related fear through an exposure treatment can be associated with restoration of functional abilities in patients with complex regional pain syndrome type I (CRPS-I). These findings suggest that pain-related fear may be associated with functional limitations in neuropathic pain as well. The aim of the current study was to test whether the debilitating role of pain-related fear generalizes to patients with CRPS-I. The results of 2 studies are presented. Study I includes a sample of patients with early CRPS-I referred to an outpatient pain clinic. In Study II, patients with chronic CRPS who are members of a patients' association were invited to participate. The results show that in early CRPS-I, pain severity but not fear of movement/(re)injury as measured with the Tampa Scale for Kinesiophobia was related to functional limitations. In patients with chronic CRPS-I, however, perceived harmfulness of activities as measured with the pictorial assessment method significantly predicted functional limitations beyond and above the contribution of pain severity. Not fear of movement/(re)injury in general, but the perceived harmfulness of activities appears a key factor that might be addressed more systematically in the clinical assessment of patients with CRPS-I. These results support the idea that pain-related fear might be a promising concept in the understanding of pain disability in patients with neuropathic pain.

Perspective: This is the first study showing that perceived harmfulness of activities contribute to the functional limitations in CRPS-I. The current findings may help clinicians customizing cognitive-behavioral treatments for patients with chronic neuropathic pain. 

Original languageEnglish
Pages (from-to)1209-1218
Number of pages10
JournalThe Journal of Pain
Volume12
Issue number12
DOIs
Publication statusPublished - Dec 2011

Keywords

  • Complex regional pain syndrome type I (CRPS-I)
  • pain-related fear
  • perceived harmfulness
  • pain severity
  • functional limitations
  • LOW-BACK-PAIN
  • REFLEX SYMPATHETIC DYSTROPHY
  • CHRONIC MUSCULOSKELETAL PAIN
  • INVARIANT 2-FACTOR MODEL
  • PSYCHOSOCIAL VARIABLES
  • DIAGNOSTIC-CRITERIA
  • AFFECTIVE PICTURES
  • PHOTOGRAPH SERIES
  • NEUROPATHIC PAIN
  • TAMPA SCALE

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