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

NCT ID: NCT05998889

Last Updated: 2024-01-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

26 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-01-25

Study Completion Date

2025-05-31

Brief Summary

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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),

Detailed Description

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Conditions

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Complex Regional Pain Syndrome I (CRPS I)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Intervention group: GPE+GMI

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

Group Type EXPERIMENTAL

Experimental group

Intervention Type BEHAVIORAL

Education, Graded Pain Exposure Exercises and Graded Motor Imagery. One supervision a week/9 weeks + exercises at home + encourage returning relevant activities despite pain

Control group: GMI

Graded Motor Imagery

Group Type ACTIVE_COMPARATOR

Control group

Intervention Type BEHAVIORAL

Graded Motor Imagery following the GRaMI protocol, One supervision a week/9 weeks + exercises at home, activities encourage but pain contingency.

Interventions

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Experimental group

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

Control group

Graded Motor Imagery following the GRaMI protocol, One supervision a week/9 weeks + exercises at home, activities encourage but pain contingency.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* No difficulties understanding Spanish or Catalan.
* Diagnosed according to Budapest criteria.

Exclusion Criteria

* 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.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Institut Català de la Salut

OTHER

Sponsor Role collaborator

University of Vic - Central University of Catalonia

OTHER

Sponsor Role lead

Responsible Party

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Jordi Alcaide Altet

Principal investigator, physiotherapist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jordi Alcaide Altet, PT

Role: PRINCIPAL_INVESTIGATOR

University of Vic - UCC

Locations

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CAP El Maresme

Mataró, Barcelona, Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Jordi Alcaide Altet, PT

Role: CONTACT

+34 666703823

Facility Contacts

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Jordi Alcaide Altet, PT

Role: primary

666703823

References

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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.

Reference Type BACKGROUND
PMID: 36650605 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 35687369 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 35579382 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 28596288 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 21474244 (View on PubMed)

Other Identifiers

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ABILITIES-1

Identifier Type: -

Identifier Source: org_study_id

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