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

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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

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