search
Back to results

Feasibility of a Combination of Graded Pain Exposure and Graded Motor Imagery in People With Complex Regional Pain Syndrome Type 1 (ABILITIES-1)

Primary Purpose

Complex Regional Pain Syndrome I (CRPS I)

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Experimental group
Control group
Sponsored by
University of Vic - Central University of Catalonia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Complex Regional Pain Syndrome I (CRPS I) focused on measuring Complex Regional Pain Syndrome, Physiotherapy (specialty), Pain Management, Exposure Therapy, Efficacy, Safety

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: No difficulties understanding Spanish or Catalan. Diagnosed according to Budapest criteria. At least 3 month from the onset event related to the development of the disease Exclusion Criteria: No diagnosis of psychological or psychiatric illness Having received any major invasive treatment (e.g: Spinal cord Implants or sympathectomy of the affected extremity). Having received any minor invasive treatment (e.g: Nerves block) in the last three months. Having any neurosensorial difficulty that could compromise the execution of the therapy proposed.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Active Comparator

    Arm Label

    Intervention group: GPE+GMI

    Control group: GMI

    Arm Description

    Pain Education program based on Neuroscience of pain and the Fear-Avoidance model + Graded Pain Exposure Exercises + Graded Motor Imagery

    Graded Motor Imagery

    Outcomes

    Primary Outcome Measures

    Severity of the disease
    Complex Regional Pain Syndrome Severity Score: This questionnaire contains self-reported items of persistent disproportionate pain, allodynia /hyperalgesia, asymmetry of temperature, color, sweating, oedema, trophic changes and motor changes . It also includes items observed by the examiner: allodynia , hyperalgesia , bilateral asymmetry of temperature by palpation, skin color changes, sweating, edema, trophic changes , and motor changes , as well as a decrease in active joint range of motion. The items are evaluated dichotomously; 0 indicates absence, and 1 indicates presence, resulting in a possible score range of 0 to 16, where higher scores indicate greater severity. The internal consistency obtained for the 16 items was adequate (Cronbach's α = 0.71).
    Safety Outcome 1: oedema
    Perimetry ( measured with a measuring tape in centimeters ) of the metacarpofalangical joint line of the affected hand or the metatarsofalangical joint line of the affected foot. Control before and after the exercise intervention. Registered in a dichotomous way, absence if no changes observed, presence if the perimeter has raised 2 centimeters or more.
    Safety Outcome 2: pain
    Changes in Verbal Pain Numerical Rating Scale after the exercises (recorded verbally). Control before and after the intervention. Registered in a dichotomous way, absence if no changes observed, presence if the Pain has raised 2 points or more.
    Safety Outcome 3: temperature
    Changes in temperature (in Celsius Degrees, taken with a Hand Infrared thermometer). Control before and after the exercise intervention at 1 cm in the center of the back of the affected hand / foot and compared to the other side. Registered in a dichotomous way, absence if no changes observed, presence if the temperature raises 2ºC or more.
    Safety outcome 4: range of motion
    Changes in active Range of Motion (measured with a finger goniometer in degrees). Control before and after the exercise intervention. Registered in a dichotomous way, absence if no changes observed, presence if active range of motion decreases 10º or more.

    Secondary Outcome Measures

    Quality, Intensity and location of pain
    Mc-Gill Short Form Questionnaire : It is a self-administered questionnaire consisting of 15 descriptors, of which 11 are sensory categories and 4 are affective. Each pain descriptor contains four columns representing the categories 0: none, 1: mild, 2: moderate, and 3: severe. Participants must mark the level of descriptor that represents their pain. There is no cutoff score in the questionnaire; higher values indicate more pain. Additionally, the questionnaire includes a visual analog scale of pain, which is a validated and reliable metric for pain assessment
    Pain pressure level
    Pain Pressure Threshold: Measured using a handheld pressure algometer (PAIN TEST™ FPX 50). Algometry has shown excellent interexaminer reliability (ICC 0.91). Pressure pain thresholds will be assessed on the dorsal side at 2 local points and one away from the hand; the local points are located at the proximal interphalangeal joint of the third finger (point 1) and at the space between the first and second metacarpals (point 2). Additionally, dorsally at the middle third of the forearm (point 3), the mean values of three consecutive measurements will be taken and compared to the contralateral side. For the lower extremity, two local points will be assessed on the foot and one at a distance; the local points are located at the metatarsophalangeal joint of the 1st (point 4) and 5th toes on the dorsal side of the foot (point 5), and the distant point is the Anterior Tibial Tuberosity of the same leg (point 6).
    Conditioned Pain Modulation
    Cold Pressure Test; The experimental tonic pain will be induced by submerging the contralateral hand in cold water following the Cold Pressor Test (conditioning stimulus), and the assessment of pressure pain thresholds (test stimulus) will be performed before and during the application of the conditioning stimulus using a handheld algometer. The Cold Pressor Test (CPT) has shown to be a superior conditioning stimulus to pain by ischemia and is widely used to evaluate conditioned pain modulation. The CPT will involve keeping the contralateral hand submerged in water at 12±1ºC up to the wrist for a period of 2 minutes. The assessment of pressure pain thresholds will begin 45 seconds after immersion; the locations will be local to the affected extremity; for the upper extremity will be performed at point 2, and for the lower extremities at point 4.
    Upper limb function
    Upper limb function will be analyzed using the Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scale. This questionnaire consists of 11 items, with a minimum of 10 items needed to be validly completed. It assesses the difficulty in performing daily activities, work-related tasks, social or family relationships, as well as pain and difficulty sleeping on a Likert scale ranging from 1 (no difficulty/problem) to 5 (unable/extremely difficult pain). The average of the responses is calculated, subtracting 1 from the total, and then multiplied by 25 to obtain a percentage related to the degree of disability, where higher values indicate greater disability. The QuickDASH has shown excellent test-retest reliability assessed by Lin's concordance coefficient of 0.80 and internal consistency greater than 0.9.
    Lower limb function
    Foot and Ankle Ability Measure: (FAAM) scale will be used. This 29-item questionnaire assesses the physical function of individuals with foot or ankle-related disabilities. It consists of two subscales: the first one with 21 items evaluates activities of daily living (ADLs), and the second one with 8 items assesses sports activities. Higher scores indicate better function. Each item is scored on a 5-point Likert scale ranging from 0 (unable to perform) to 4 (no difficulty), with the option to answer N/A (not applicable) in case the activity is limited by any other aspect not related to the foot or ankle. The FAAM scale demonstrates high internal consistency (Cronbach's α for ADLs 0.97 and for sports 0.93) and test-retest reliability for ADLs (ICC=0.90) and for sports (ICC=0.76)
    Quality of life (EQ-5D-5L)
    EQ-5D-5L questionnaire: The EuroQoL 5 dimensions 5 levels questionnaire assesses quality of life through five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The EQ-5D-5L has demonstrated efficacy, reliability, and discriminative ability in multiple pathologies and populations. Users evaluate their perception of each dimension at the moment of assessment and have five Likert-type options ranging from 1 ("no problems") to 5 ("extreme problems"). The questionnaire also includes a Visual Analog Scale (VAS) for perceived quality of life. The set of values is categorized into a 5-digit code. The VAS is marked with a cross, and it indicates the perceived health status on that particular day.
    Catastrophism
    Pain Catastrophizing Scale (PCS). The PCS is a self-administered questionnaire that assesses the construct of "Pain Catastrophizing" in response to the modulation of painful stimuli. It consists of 13 items that assess three different dimensions: rumination (items 8, 9, 10, 11), magnification (items 6, 7, 13), and helplessness (items 1, 2, 3, 4, 5, 12). The PCS shows reliable test-retest parameters (0.79) and internal consistency (Cronbach's α of 0.84)
    Self-efficacy
    Self-efficacy in Chronic Pain Questionnaire: this questionnaire assesses three dimensions with 22 items: self-efficacy in symptom control (items 1-8), self-efficacy in physical functioning (items 9-17), and self-efficacy in pain management (items 18-22). Each question is scored from 0 ("not at all capable") to 10 ("completely capable"), with a range of values from 0 to 100. The questionnaire has a test-retest reliability of r=0.75 and internal consistency (Cronbach's α of 0.91).
    Strength
    Hand-grip strength measured with a dynamometer: isometric handgrip strength will be calculated on the affected side using a JAMAR hydraulic dynamometer, while seated with a straight back and feet touching the ground. The elbow is flexed at a 90° angle, in a neutral position of forearm pronation and supination, close to the body, with a neutral wrist position, and in the most comfortable device position for the user (42). The user will be instructed to squeeze the device as hard as possible upon verbal command. Three measurements will be taken with 5 seconds of rest between each. The test-retest reliability of the handgrip strength measurement with this dynamometer is very high (r=0.88-0.93)

    Full Information

    First Posted
    July 25, 2023
    Last Updated
    August 10, 2023
    Sponsor
    University of Vic - Central University of Catalonia
    Collaborators
    Institut Català de la Salut
    search

    1. Study Identification

    Unique Protocol Identification Number
    NCT05998889
    Brief Title
    Feasibility of a Combination of Graded Pain Exposure and Graded Motor Imagery in People With Complex Regional Pain Syndrome Type 1
    Acronym
    ABILITIES-1
    Official Title
    A Feasibility Study of a Combination of Graded Pain Exposure and Graded Motor Imagery in People With Complex Regional Pain Syndrome Type 1
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    August 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    January 2024 (Anticipated)
    Primary Completion Date
    December 2024 (Anticipated)
    Study Completion Date
    May 2025 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    University of Vic - Central University of Catalonia
    Collaborators
    Institut Català de la Salut

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    Background: There is low quality evidence supporting the use of rehabilitation in Complex Regional Pain Syndrome (CRPS), despite it is the first line approach in the Guidelines . Graded Motor Imagery (GMI) may be useful to improve pain and function at mid term (6 months). Graded Pain Exposure Approaches (GPE) seem to improve pain but not function at mid term. In other type of chronic pain conditions GPE offers better outcomes than "pain contingent" (exercises avoiding pain) approaches at short term (3 months) and similar at mid term. Following the recommendations of Authors, we will evaluate the efficacy and safety of a combined therapy of GMI and GPE in people with CRPS type 1. Objective: To evaluate the feasibility of a combined therapy of GPE and GMI in front of only GMI in people with CRPS-1 and the clinical impact on the primary outcome (Severity of the disease) of the intervention. Design: Feasibility Randomized controlled Trial, single blind of evaluator, 2 parallel arms. Measurement pre-intervention, post-intervention , 1 and 3 months follow-up. Population: People 18 years old or above with CRPS type 1 diagnosed by Budapest criteria and (1) without any psychological or psychiatric disease, (2) nor any neurosensorial issue that could compromise the realization of the therapy proposed (3) neither any major surgery intervention related to CRPS (e.g neurostimulation or sympathectomy) (4) nor minor intervention on the last 3 months (e.g. nerve blocks). Outcomes: Primary outcomes: Complex Regional Pain Syndrome Severity Scale (severity of the disease) and Safety Outcomes ( oedema, pain, temperature, Range of Motion). Secondary outcomes: 5Q-5D-5L (quality of life), SF-MPQ (Quality, Intensity and location of pain), PPT (pain pressure threshold), CPM ( pain inhibition pathways), FAAM or Quick Dash (function), PCS (catastrophism), Self efficacy in chronic pain questionnaire (self-efficacy), Dynamometry (Hand Grip strength),

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Complex Regional Pain Syndrome I (CRPS I)
    Keywords
    Complex Regional Pain Syndrome, Physiotherapy (specialty), Pain Management, Exposure Therapy, Efficacy, Safety

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Masking
    Outcomes Assessor
    Allocation
    Randomized
    Enrollment
    40 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Intervention group: GPE+GMI
    Arm Type
    Experimental
    Arm Description
    Pain Education program based on Neuroscience of pain and the Fear-Avoidance model + Graded Pain Exposure Exercises + Graded Motor Imagery
    Arm Title
    Control group: GMI
    Arm Type
    Active Comparator
    Arm Description
    Graded Motor Imagery
    Intervention Type
    Behavioral
    Intervention Name(s)
    Experimental group
    Intervention Description
    Education, Graded Pain Exposure Exercises and Graded Motor Imagery. One supervision a week/9 weeks + exercises at home + encourage returning relevant activities despite pain
    Intervention Type
    Behavioral
    Intervention Name(s)
    Control group
    Intervention Description
    Graded Motor Imagery following the GRaMI protocol, One supervision a week/9 weeks + exercises at home, activities encourage but pain contingency.
    Primary Outcome Measure Information:
    Title
    Severity of the disease
    Description
    Complex Regional Pain Syndrome Severity Score: This questionnaire contains self-reported items of persistent disproportionate pain, allodynia /hyperalgesia, asymmetry of temperature, color, sweating, oedema, trophic changes and motor changes . It also includes items observed by the examiner: allodynia , hyperalgesia , bilateral asymmetry of temperature by palpation, skin color changes, sweating, edema, trophic changes , and motor changes , as well as a decrease in active joint range of motion. The items are evaluated dichotomously; 0 indicates absence, and 1 indicates presence, resulting in a possible score range of 0 to 16, where higher scores indicate greater severity. The internal consistency obtained for the 16 items was adequate (Cronbach's α = 0.71).
    Time Frame
    Pre-treatment, post-treatment (9 weeks) and at 1 and 3 months follow-up after treatment.
    Title
    Safety Outcome 1: oedema
    Description
    Perimetry ( measured with a measuring tape in centimeters ) of the metacarpofalangical joint line of the affected hand or the metatarsofalangical joint line of the affected foot. Control before and after the exercise intervention. Registered in a dichotomous way, absence if no changes observed, presence if the perimeter has raised 2 centimeters or more.
    Time Frame
    Weekly during during the intervention (9 weeks)
    Title
    Safety Outcome 2: pain
    Description
    Changes in Verbal Pain Numerical Rating Scale after the exercises (recorded verbally). Control before and after the intervention. Registered in a dichotomous way, absence if no changes observed, presence if the Pain has raised 2 points or more.
    Time Frame
    Weekly during during the intervention (9 weeks)
    Title
    Safety Outcome 3: temperature
    Description
    Changes in temperature (in Celsius Degrees, taken with a Hand Infrared thermometer). Control before and after the exercise intervention at 1 cm in the center of the back of the affected hand / foot and compared to the other side. Registered in a dichotomous way, absence if no changes observed, presence if the temperature raises 2ºC or more.
    Time Frame
    Weekly during during the intervention (9 weeks)
    Title
    Safety outcome 4: range of motion
    Description
    Changes in active Range of Motion (measured with a finger goniometer in degrees). Control before and after the exercise intervention. Registered in a dichotomous way, absence if no changes observed, presence if active range of motion decreases 10º or more.
    Time Frame
    Weekly during during the intervention (9 weeks)
    Secondary Outcome Measure Information:
    Title
    Quality, Intensity and location of pain
    Description
    Mc-Gill Short Form Questionnaire : It is a self-administered questionnaire consisting of 15 descriptors, of which 11 are sensory categories and 4 are affective. Each pain descriptor contains four columns representing the categories 0: none, 1: mild, 2: moderate, and 3: severe. Participants must mark the level of descriptor that represents their pain. There is no cutoff score in the questionnaire; higher values indicate more pain. Additionally, the questionnaire includes a visual analog scale of pain, which is a validated and reliable metric for pain assessment
    Time Frame
    Pre-treatment, post-treatment (9 weeks) and at 1 and 3 months follow-up after treatment.
    Title
    Pain pressure level
    Description
    Pain Pressure Threshold: Measured using a handheld pressure algometer (PAIN TEST™ FPX 50). Algometry has shown excellent interexaminer reliability (ICC 0.91). Pressure pain thresholds will be assessed on the dorsal side at 2 local points and one away from the hand; the local points are located at the proximal interphalangeal joint of the third finger (point 1) and at the space between the first and second metacarpals (point 2). Additionally, dorsally at the middle third of the forearm (point 3), the mean values of three consecutive measurements will be taken and compared to the contralateral side. For the lower extremity, two local points will be assessed on the foot and one at a distance; the local points are located at the metatarsophalangeal joint of the 1st (point 4) and 5th toes on the dorsal side of the foot (point 5), and the distant point is the Anterior Tibial Tuberosity of the same leg (point 6).
    Time Frame
    Pre-treatment, post-treatment (9 weeks) and at 1 and 3 months follow-up after treatment.
    Title
    Conditioned Pain Modulation
    Description
    Cold Pressure Test; The experimental tonic pain will be induced by submerging the contralateral hand in cold water following the Cold Pressor Test (conditioning stimulus), and the assessment of pressure pain thresholds (test stimulus) will be performed before and during the application of the conditioning stimulus using a handheld algometer. The Cold Pressor Test (CPT) has shown to be a superior conditioning stimulus to pain by ischemia and is widely used to evaluate conditioned pain modulation. The CPT will involve keeping the contralateral hand submerged in water at 12±1ºC up to the wrist for a period of 2 minutes. The assessment of pressure pain thresholds will begin 45 seconds after immersion; the locations will be local to the affected extremity; for the upper extremity will be performed at point 2, and for the lower extremities at point 4.
    Time Frame
    Pre-treatment, post-treatment (9 weeks) and at 1 and 3 months follow-up after treatment.
    Title
    Upper limb function
    Description
    Upper limb function will be analyzed using the Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scale. This questionnaire consists of 11 items, with a minimum of 10 items needed to be validly completed. It assesses the difficulty in performing daily activities, work-related tasks, social or family relationships, as well as pain and difficulty sleeping on a Likert scale ranging from 1 (no difficulty/problem) to 5 (unable/extremely difficult pain). The average of the responses is calculated, subtracting 1 from the total, and then multiplied by 25 to obtain a percentage related to the degree of disability, where higher values indicate greater disability. The QuickDASH has shown excellent test-retest reliability assessed by Lin's concordance coefficient of 0.80 and internal consistency greater than 0.9.
    Time Frame
    Pre-treatment, post-treatment (9 weeks) and at 1 and 3 months follow-up after treatment.
    Title
    Lower limb function
    Description
    Foot and Ankle Ability Measure: (FAAM) scale will be used. This 29-item questionnaire assesses the physical function of individuals with foot or ankle-related disabilities. It consists of two subscales: the first one with 21 items evaluates activities of daily living (ADLs), and the second one with 8 items assesses sports activities. Higher scores indicate better function. Each item is scored on a 5-point Likert scale ranging from 0 (unable to perform) to 4 (no difficulty), with the option to answer N/A (not applicable) in case the activity is limited by any other aspect not related to the foot or ankle. The FAAM scale demonstrates high internal consistency (Cronbach's α for ADLs 0.97 and for sports 0.93) and test-retest reliability for ADLs (ICC=0.90) and for sports (ICC=0.76)
    Time Frame
    Pre-treatment, post-treatment (9 weeks) and at 1 and 3 months follow-up after treatment.
    Title
    Quality of life (EQ-5D-5L)
    Description
    EQ-5D-5L questionnaire: The EuroQoL 5 dimensions 5 levels questionnaire assesses quality of life through five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The EQ-5D-5L has demonstrated efficacy, reliability, and discriminative ability in multiple pathologies and populations. Users evaluate their perception of each dimension at the moment of assessment and have five Likert-type options ranging from 1 ("no problems") to 5 ("extreme problems"). The questionnaire also includes a Visual Analog Scale (VAS) for perceived quality of life. The set of values is categorized into a 5-digit code. The VAS is marked with a cross, and it indicates the perceived health status on that particular day.
    Time Frame
    Pre-treatment, post-treatment (9 weeks) and at 1 and 3 months follow-up after treatment.
    Title
    Catastrophism
    Description
    Pain Catastrophizing Scale (PCS). The PCS is a self-administered questionnaire that assesses the construct of "Pain Catastrophizing" in response to the modulation of painful stimuli. It consists of 13 items that assess three different dimensions: rumination (items 8, 9, 10, 11), magnification (items 6, 7, 13), and helplessness (items 1, 2, 3, 4, 5, 12). The PCS shows reliable test-retest parameters (0.79) and internal consistency (Cronbach's α of 0.84)
    Time Frame
    Pre-treatment, post-treatment (9 weeks) and at 1 and 3 months follow-up after treatment.
    Title
    Self-efficacy
    Description
    Self-efficacy in Chronic Pain Questionnaire: this questionnaire assesses three dimensions with 22 items: self-efficacy in symptom control (items 1-8), self-efficacy in physical functioning (items 9-17), and self-efficacy in pain management (items 18-22). Each question is scored from 0 ("not at all capable") to 10 ("completely capable"), with a range of values from 0 to 100. The questionnaire has a test-retest reliability of r=0.75 and internal consistency (Cronbach's α of 0.91).
    Time Frame
    Pre-treatment, post-treatment (9 weeks) and at 1 and 3 months follow-up after treatment.
    Title
    Strength
    Description
    Hand-grip strength measured with a dynamometer: isometric handgrip strength will be calculated on the affected side using a JAMAR hydraulic dynamometer, while seated with a straight back and feet touching the ground. The elbow is flexed at a 90° angle, in a neutral position of forearm pronation and supination, close to the body, with a neutral wrist position, and in the most comfortable device position for the user (42). The user will be instructed to squeeze the device as hard as possible upon verbal command. Three measurements will be taken with 5 seconds of rest between each. The test-retest reliability of the handgrip strength measurement with this dynamometer is very high (r=0.88-0.93)
    Time Frame
    Pre-treatment, post-treatment (9 weeks) and at 1 and 3 months follow-up after treatment.

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: No difficulties understanding Spanish or Catalan. Diagnosed according to Budapest criteria. At least 3 month from the onset event related to the development of the disease Exclusion Criteria: No diagnosis of psychological or psychiatric illness Having received any major invasive treatment (e.g: Spinal cord Implants or sympathectomy of the affected extremity). Having received any minor invasive treatment (e.g: Nerves block) in the last three months. Having any neurosensorial difficulty that could compromise the execution of the therapy proposed.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Jordi Alcaide Altet, PT
    Phone
    +34 666703823
    Email
    jordi.alcaide@uvic.cat
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Jordi Alcaide Altet, PT
    Organizational Affiliation
    University of Vic - UCC
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No
    Citations:
    PubMed Identifier
    36650605
    Citation
    Shafiee E, MacDermid J, Packham T, Walton D, Grewal R, Farzad M. The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome: A Systematic Review and Meta-analysis. Clin J Pain. 2023 Feb 1;39(2):91-105. doi: 10.1097/AJP.0000000000001089.
    Results Reference
    background
    PubMed Identifier
    35687369
    Citation
    Harden RN, McCabe CS, Goebel A, Massey M, Suvar T, Grieve S, Bruehl S. Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 5th Edition. Pain Med. 2022 Jun 10;23(Suppl 1):S1-S53. doi: 10.1093/pm/pnac046.
    Results Reference
    background
    PubMed Identifier
    35579382
    Citation
    Smart KM, Ferraro MC, Wand BM, O'Connell NE. Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II. Cochrane Database Syst Rev. 2022 May 17;5(5):CD010853. doi: 10.1002/14651858.CD010853.pub3.
    Results Reference
    background
    PubMed Identifier
    28596288
    Citation
    Smith BE, Hendrick P, Smith TO, Bateman M, Moffatt F, Rathleff MS, Selfe J, Logan P. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017 Dec;51(23):1679-1687. doi: 10.1136/bjsports-2016-097383. Epub 2017 Jun 8.
    Results Reference
    background
    PubMed Identifier
    21474244
    Citation
    van de Meent H, Oerlemans M, Bruggeman A, Klomp F, van Dongen R, Oostendorp R, Frolke JP. Safety of "pain exposure" physical therapy in patients with complex regional pain syndrome type 1. Pain. 2011 Jun;152(6):1431-1438. doi: 10.1016/j.pain.2011.02.032. Epub 2011 Apr 6.
    Results Reference
    background

    Learn more about this trial

    Feasibility of a Combination of Graded Pain Exposure and Graded Motor Imagery in People With Complex Regional Pain Syndrome Type 1

    We'll reach out to this number within 24 hrs