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Scand J Pain. 2017 Apr;15:30-37. doi: 10.1016/j.sjpain.2016.11.003. Epub 2016 Dec 9.

Pain reduction due to novel sensory-motor training in Complex Regional Pain Syndrome I - A pilot study.

Author information

1
Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Germany; Department of Neural and Pain Sciences, University of Maryland, Baltimore MD, USA; Neurosurgery, Johns Hopkins University, Baltimore MD, USA; Brain Imaging and NeuroStimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Clinical Neuroengineering, BrainMind Institute and Centre of Neuroprosthetics (CNP), Swiss Federal Institute of Technology (EPFL) Geneva, Switzerland and Swiss Federal Institute of Technology Valais (EPFL Valais), Sion, Switzerland. Electronic address: Schmid.AnneChristine@gmail.com.
2
Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Germany.
3
Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Germany; Neuroscience Research Australia, Australia; School of Psychology, University of New South Wales, Australia.
4
Department of Neural and Pain Sciences, University of Maryland, Baltimore MD, USA; Center to Advance Chronic Pain Research, University of Maryland, Baltimore MD, USA.
5
Clinical Neuroengineering, BrainMind Institute and Centre of Neuroprosthetics (CNP), Swiss Federal Institute of Technology (EPFL) Geneva, Switzerland and Swiss Federal Institute of Technology Valais (EPFL Valais), Sion, Switzerland.
6
Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Germany; WyssCenter of Bio- and Neuroengeneering, Geneva, Swizerland.

Abstract

BACKGROUND AND AIMS:

Patients suffering from Complex Regional Pain Syndrome (CRPS) of the upper limb show a changed cortical representation of the affected hand. The lip area invades the former hand area contralateral to the affected hand. This change in cortical representation is correlated to the intensity of ongoing pain in patients with CRPS. Further studies revealed that restoration of the original representation coincides with a decrease of pain. Sensory-motor training protocols can increase and/or relocate cortical somatosensory and motor representation areas of the fingers, as shown, for example, in Braille reading individuals and professional violin players. Further, there is evidence that sensory-motor discrimination training has a beneficial effect on both the intensity of pain and the mislocalization of sensory-motor cortical areas in CRPS patients. Based on these propositions, we developed a novel sensory-motor self-training paradigm for CRPS patients to use in a home-based manner.

METHODS:

Ten CRPS patients performed the sensory-motor training for 2weeks. The training consists of a braille-like haptic task with different training modes (bi-manual, speed and memory training). During the training, as well as 1week before and after, patients were asked to fill out pain diaries. Furthermore, measures of impairment were acquired at baseline and post training.

RESULTS:

Patients showed significant pain reduction after the 2week training period. The overall disability as well as the depression scores showed a trend to improve after the 2week training. The reduction in pain was correlated with the total amount of training performed.

CONCLUSIONS:

This is a first proof of principle study of a novel sensory-motor self-training protocol to reduce pain in CRPS patients. The more consistent the patients trained the larger the pain reduction. Sensory-motor training, which can be performed on a regular basis at home might provide a novel interventional strategy to improve symptoms of CRPS.

IMPLICATIONS:

Although a larger study needs to be conducted to confirm our findings, including long-term follow-up, the results show, that a sensory-motor home-based training is a strategy worth exploring further for the reduction of pain as well as high frequency training for patients with CRPS.

KEYWORDS:

Complex Regional Pain Syndrome; Neuropathic pain; Sensory-motor training

PMID:
28850342
DOI:
10.1016/j.sjpain.2016.11.003
[Indexed for MEDLINE]

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