Pain Reduction by Inducing Sensory-Motor Adaptation in Complex Regional Pain Syndrome (CRPS PRISMA): Protocol for a Double-blind Randomized Controlled Trial

AbstractBackgroundComplex Regional Pain Syndrome (CRPS) presents as chronic, continuous pain and sensory, autonomic, and motor abnormalities affecting one or more extremities. People with CRPS can also show changes in their perception of and attention to the affected body part and sensory information in the affected side of space. Prism Adaptation (PA) is a behavioural intervention targeted at reducing attention deficits in post-stroke hemispatial neglect. PA also appears to reduce pain and other CRPS symptoms; however, these therapeutic effects have been demonstrated only in small unblinded studies. This paper describes the protocol for an ongoing double-blind, randomized, sham-controlled clinical trial that will evaluate the efficacy of PA treatment for CRPS. The secondary aims of the study are to examine the relationships between neuropsychological changes (such as spatial attention, space and body representation, and motor spatial performance) and clinical manifestations of CRPS, as well as symptom improvement.MethodsForty-two participants with upper-limb CRPS type I will undergo two weeks of twice-daily PA treatment or sham treatment. The primary outcome measures are current pain intensity and CRPS severity score, measured immediately before and after the treatment period. Secondary outcome measures include the results of self-report questionnaires about pain, movement, symptoms interference, and body representation; clinical assessments of sensory, motor, and autonomic functions; and computer-based psychophysical tests of neuropsychological functions. Data are collected in four research visits: four weeks and one day before treatment, and one day and four weeks after the end of treatment. Additional follow-up through postal questionnaires is conducted three and six months post-treatment.DiscussionIt is hypothesised that participants undergoing PA treatment, compared to those receiving sham treatment, will show greater reduction in pain and CRPS severity score, and improvements on other clinical and neuropsychological measures. Also, more pronounced neuropsychological symptoms are predicted to correlate with more severe clinical CRPS symptoms. This study will provide the first randomized double-blind evaluation of the therapeutic effects of PA that could be implemented as a rehabilitation method for CRPS, and will contribute to the understanding of how neuropsychological changes in body representation and attention pertain to the manifestation and treatment of CRPS.

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Pain reduction by inducing sensory-motor adaptation in Complex Regional Pain Syndrome (CRPS PRISMA): protocol for a double-blind randomized controlled trial

BMC Neurology ◽

10.1186/s12883-020-1604-z ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 5

Author(s):

Monika Halicka ◽

Axel D. Vittersø ◽

Michael J. Proulx ◽

Janet H. Bultitude

Keyword(s):

Randomized Controlled Trial ◽

Complex Regional Pain Syndrome ◽

Controlled Trial ◽

Motor Adaptation ◽

Pain Syndrome ◽

Pain Reduction ◽

Double Blind ◽

Randomized Controlled ◽

Sensory Motor

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Prism adaptation treatment for upper-limb Complex Regional Pain Syndrome: a double-blind randomized controlled trial

10.1101/2020.03.18.20038109 ◽

2020 ◽

Cited By ~ 1

Author(s):

Monika Halicka ◽

Axel D. Vittersø ◽

Hayley McCullough ◽

Andreas Goebel ◽

Leila Heelas ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Complex Regional Pain Syndrome ◽

Upper Limb ◽

Controlled Trial ◽

Pain Syndrome ◽

Prism Adaptation ◽

Double Blind ◽

Sham Treatment ◽

Randomized Controlled ◽

Secondary Outcomes

AbstractInitial evidence suggested that people with Complex Regional Pain Syndrome (CRPS) have reduced attention to the affected side of their body and the surrounding space, which might be related to pain and other clinical symptoms. Three previous unblinded, uncontrolled studies showed pain relief following treatment with prism adaptation, an intervention that has been used to counter lateralised attention bias in brain-lesioned patients. To provide a robust test of its effectiveness for CRPS, we conducted a double-blind randomized controlled trial of prism adaptation for unilateral upper-limb CRPS-I. Forty-nine eligible adults with CRPS were randomized to undergo two-weeks of twice-daily home-based prism adaptation treatment (n = 23) or sham treatment (n = 26). Outcomes were assessed in person four weeks prior to and immediately before treatment, and immediately after and four weeks post-treatment. Long-term postal follow-ups were conducted three and six months after treatment. We examined the effects of prism adaptation versus sham treatment on current pain intensity and CRPS symptom severity score (primary outcomes); as well as sensory, motor, and autonomic functions, self-reported psychological functioning, and experimentally tested neuropsychological functions (secondary outcomes). We found no evidence that primary or secondary outcomes differed between the prism adaptation and sham treatment groups when tested at either time point following treatment. Overall, CRPS severity significantly decreased over time for both groups, but we found no benefits of prism adaptation beyond sham treatment. Our findings do not support the efficacy of prism adaptation treatment for relieving upper-limb CRPS-I. This trial was prospectively registered (ISRCTN46828292).

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Neuropsychological Changes in Complex Regional Pain Syndrome (CRPS)

Behavioural Neurology ◽

10.1155/2020/4561831 ◽

2020 ◽

Vol 2020 ◽

pp. 1-30 ◽

Cited By ~ 4

Author(s):

Monika Halicka ◽

Axel D. Vittersø ◽

Michael J. Proulx ◽

Janet H. Bultitude

Keyword(s):

Chronic Pain ◽

Complex Regional Pain Syndrome ◽

Cognitive Functions ◽

Clinical Signs ◽

Pain Syndrome ◽

Body Representation ◽

Neuropsychological Changes ◽

Neuropsychological Functions ◽

Higher Cognitive Functions ◽

Chronic Pain Conditions

Complex Regional Pain Syndrome (CRPS) is a poorly understood chronic pain condition of multifactorial origin. CRPS involves sensory, motor, and autonomic symptoms primarily affecting one extremity. Patients can also present with neuropsychological changes such as reduced attention to the CRPS-affected extremity, reminiscent of hemispatial neglect, yet in the absence of any brain lesions. However, this “neglect-like” framework is not sufficient to characterise the range of higher cognitive functions that can be altered in CRPS. This comprehensive literature review synthesises evidence of neuropsychological changes in CRPS in the context of potential central mechanisms of the disorder. The affected neuropsychological functions constitute three distinct but not independent groups: distorted body representation, deficits in lateralised spatial cognition, and impairment of non-spatially-lateralised higher cognitive functions. We suggest that many of these symptoms appear to be consistent with a broader disruption to parietal function beyond merely what could be considered “neglect-like.” Moreover, the extent of neuropsychological symptoms might be related to the clinical signs of CRPS, and rehabilitation methods that target the neuropsychological changes can improve clinical outcomes in CRPS and other chronic pain conditions. Based on the limitations and gaps in the reviewed literature, we provide several suggestions to improve further research on neuropsychological changes in chronic pain.

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Faculty Opinions recommendation of Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: a double-blind placebo controlled study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1528961.1017059 ◽

2010 ◽

Author(s):

Michael Serpell

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Controlled Study ◽

Double Blind ◽

Double Blind Placebo ◽

Intravenous Ketamine

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Faculty Opinions recommendation of Therapeutic effects of lidocaine patch on myofascial pain syndrome of the upper trapezius: a randomized, double-blind, placebo-controlled study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718173019.793487050 ◽

2013 ◽

Author(s):

Rajesh Gupta

Keyword(s):

Myofascial Pain ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Controlled Study ◽

Therapeutic Effects ◽

Double Blind ◽

Double Blind Placebo ◽

Upper Trapezius ◽

Lidocaine Patch

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Poster 314 Complex Regional Pain Syndrome Severity Score: Development of A Clinical Tool For Monitoring Disease Evolution

PM&R ◽

10.1016/j.pmrj.2011.08.342 ◽

2011 ◽

Vol 3 ◽

pp. S281-S281

Author(s):

Anjum Sayyad ◽

Joseph R. Graciosa ◽

R.N. Harden ◽

Geneva Jacobs ◽

Maxine M. Kuroda ◽

...

Keyword(s):

Complex Regional Pain Syndrome ◽

Severity Score ◽

Pain Syndrome ◽

Clinical Tool ◽

Disease Evolution

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CRPS: what’s in a name? Taxonomy, epidemiology, neurologic, immune and autoimmune considerations

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-100064 ◽

2019 ◽

Vol 44 (3) ◽

pp. 376-387 ◽

Cited By ~ 5

Author(s):

Michael d‘A Stanton-Hicks

Keyword(s):

Nervous System ◽

Autonomic Nervous System ◽

Complex Regional Pain Syndrome ◽

Severity Score ◽

Clinical Management ◽

Pain Syndrome ◽

Clinical Syndromes ◽

Shed Light ◽

Historical Origins

This account of the condition now termed complex regional pain syndrome (CRPS) spans approximately 462 years since a description embodying similar clinical features was described by Ambroise Paré in 1557. While reviewing its historical origins, the text describes why it became necessary to change the taxonomies of two clinical syndromes with similar pathophysiologies to one which acknowledges this aspect but does not introduce any mechanistic overtones. Discussed at length is the role of the sympathetic component of the autonomic nervous system (ANS) and why its dysfunction has both directly and indirectly influenced our understanding of the inflammatory aspects of CRPS. As the following article will show, our knowledge has expanded in an exponential fashion to include musculoskeletal, immune, autoimmune, central and peripheral nervous system and ANS dysfunction, all of which increase the complexity of its clinical management. A burgeoning literature is beginning to shed light on the mechanistic aspects of these syndromes and the increasing evidence of a genetic influence on such factors as autoimmunity, and its importance is also discussed at length. An important aspect that has been missing from the diagnostic criteria is a measure of disease severity. The recent validation of a CRPS Severity Score is also included.

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