Complex Regional Pain Syndromes
Conditions
Keywords
Complex Regional Pain Syndrome, Primary chronic pain, Body perception disturbances, Graded Motor Imagery
Brief summary
Complex Regional Pain Syndrome (CRPS) is a debilitating pain condition that usually develops following trauma. Patients with CRPS experience intense, continuing, disproportionate pain and multiple symptoms such as changes or asymmetry in colour, temperature or oedema, as well as stiffness, tremors or dystonia and body perception disturbances. Body perception disturbances are now recognised as part of the typical presentation of CRPS and have been shown to correlate, in particular, with pain intensity. Managing CRPS is challenging and treatment options are limited. Among these, treatments aimed at cortical reorganisation, such as Graded Motor Imagery (GMI), have shown evidence of efficacy in terms of pain and function. However, with regard to body perception disorders, the evidence is limited and emerging. Our aim is to evaluate the effects of Graded Motor Imagery on body perception disorders in patients with upper limb CRPS. Method: a randomised controlled trial comparing an intervention group - therapeutic exercises plus GMI for 6 weeks (implicit motor imagery, explicit motor imagery followed by mirror therapy) - with a control group - therapeutic exercises plus sham-GMI (non-motor mental imagery) for 6 weeks. Outcome measures: body perception disorders (Bath Scale), pain intensity (Numerical Rating Scale), quality of life (PROMIS 29), catastrophising (PCS), fear of pain, CRPS Severity Score, patient-reported global impression of change, medication use and self-efficacy. Interventions are carried out in private practice by independent physiotherapists. Assessors are blinded for the primary outcome. A qualitative component will explore the experiences and perceptions of patients and therapists regarding body perception disturbances, GMI and participation in a research project. This study aims are to improve treatment options for the management of SDRC and to improve the recognition and treatment of body perception disorders in SDRC.
Interventions
OTHERGraded Motor Imagery + Therapeutic exercises
Functional, mobility, strengthening, and mobilization exercises, both passive and active. The exercises are designed to improve mobility and function in the affected limb. In addition to this standard treatment, the intervention group will receive care using Gradual Motor Imagery. The protocol lasts 6 weeks (3 sessions of 15 minutes per day), divided into 3 phases: implicit motor imagery, explicit motor imagery followed by mirror therapy
OTHERSham-GMI (non-motor mental imagery) + Therapeutic exercises
Functional, mobility, strengthening, and mobilization exercises, both passive and active. The exercises are designed to improve mobility and function in the affected limb. In addition to this standard treatment, the control group will receive a non-motor mental imagery intervention (visual imagery or sham-GMI), designed not to stimulate the sensorimotor areas of the brain while resembling IMG (3 sessions of 15 minutes per day for 6 weeks).
Sponsors
Nantes University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Randomized controlled trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Over 18 years * Upper limb unilateral CRPS (Budapest criteria) * No prior use of GMI
Exclusion criteria
* Psychiatric disorders * Not confident with written/spoken French * Not confident with smartphone use
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Body perception disorders (Bath Scale) | End of intervention (Week 6) | Assessment of body perception disturbances; 7 items |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Body perception disorders (Bath Scale) | 3 months after intervention (M3) | Assessment of body perception disturbances; 7 items |
| Mean pain intensity (Numeric rating scale) | End of intervention (Week 6), 3 months after intervention (M3) | Mean pain during the last week, mean pain during the last week during movement, mean pain during the last week at rest |
| QuickDash | End of intervention (Week 6), 3 months after intervention (M3) | Self-reported assessment of upper limb function : |
| PROMIS 29 | End of intervention (Week 6), 3 months after intervention (M3) | Self-reported assessment of quality of life (7 domains, 29 items) |
| Pain Catastrophizing Scale (PCS) | End of intervention (Week 6), 3 months after intervention (M3) | Self-reported assessment of pain catastrophizing |
| Tampa Scale of Kinesiophobia (short form) | End of intervention (Week 6), 3 months after intervention (M3) | Self-reported assessment of fear of movement (6 items) |
| Pain Self Efficacy Questionnaire (PSEQ) | End of intervention (Week 6), 3 months after intervention (M3) | Self-reported assessment of confidence in performing activities despite ongoing pain |
| Patient Global Impression of Change (PGIC) | End of intervention (Week 6), 3 months after intervention (M3) | Self-administered questions asking respondents to rate how their condition has changed since the intervention |
| Medication Quantification Scale (MQS) | End of intervention (Week 6), 3 months after intervention (M3) | MQS quantifies pain medication use and provides a score. |
Countries
France
Contacts
CONTACTSessi ACAPO, Doctor of Science
Outcome results
None listed