Are pain-related fears mediators for reducing disability and pain in patients with complex regional pain syndrome type 1? An explorative analysis on pain exposure physical therapy.
OBJECTIVE
To investigate whether pain-related fears are mediators for reducing disability and pain in patients with Complex Regional Pain Syndrome type 1 when treating with Pain Exposure Physical Therapy.


METHODS
An explorative secondary analysis of a randomised controlled trial.


METHODS
Fifty-six patients with Complex Regional Pain Syndrome type 1.


METHODS
The experimental group received Pain Exposure Physical Therapy in a maximum of five treatment sessions; the control group received conventional treatment following the Dutch multidisciplinary guideline.


METHODS
Levels of disability, pain, and pain-related fears (fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were measured at baseline and after 3, 6, and 9 months follow-up.


RESULTS
The experimental group had a significantly larger decrease in disability of 7.77 points (95% CI 1.09 to 14.45) and in pain of 1.83 points (95% CI 0.44 to 3.23) over nine months than the control group. The potential mediators pain-related fears decreased significantly in both groups, but there were no significant differences between groups, which indicated that there was no mediation.


CONCLUSIONS
The reduction of pain-related fears was comparable in both groups. We found no indication that pain-related fears mediate the larger reduction of disability and pain in patients with Complex Regional Pain Syndrome type 1 treated with Pain Exposure Physical Therapy compared to conventional treatment.


BACKGROUND
International Clinical Trials Registry NCT00817128.
Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, The Netherlands.
Karlijn J
KJ
Barnhoorn
Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, The Netherlands.
J Bart
JB
Staal
Department of Anaesthesiology, Pain and Palliative Care, Radboud university medical center, Nijmegen, The Netherlands.
Robert T M
RT
van Dongen
Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands.
Jan Paul M
JP
Frölke
Department of Orthopaedics, Section Physical Therapy, Radboud university medical center, Nijmegen, The Netherlands.
Frank P
FP
Klomp
Department of Rehabilitation, Radboud university medical center, Nijmegen, The Netherlands.
Henk
H
van de Meent
Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands.
Han
H
Samwel
Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, The Netherlands; Department of Rehabilitation, Radboud university medical center, Nijmegen, The Netherlands.
Maria W G
MW
Nijhuis-van der Sanden
D000328:Adult; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000534:rehabilitation; D010147:Pain Measurement / Q000379:methods; D012019:Reflex Sympathetic Dystrophy / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation*; D016896:Treatment Outcome