title: Expose or protect? A randomized controlled trial of exposure in vivo vs pain-contingent treatment as usual in patients with complex regional pain syndrome type 1.
abstract: Complex regional pain syndrome type I (CRPS-I) highly affects patients' ability to perform daily life activities. Pain-related fear might be a key target to reduce disability in chronic pain. Current treatments aiming at reducing pain show little improvements on pain and disability, whereas novel exposure-based treatments targeting pain-related fears have shown to be promising. We conducted a randomized controlled trial (N = 46) comparing exposure in vivo (EXP) with pain-contingent treatment as usual (TAU), for CRPS-I patients with at least moderate levels of pain-related fear. Primary outcome is self-reported disability, for upper and lower extremity, respectively. Secondary outcomes are self-reported pain-intensity, pain-catastrophizing, perceived harmfulness of physical activity, and health-related quality of life. Pretreatment to posttreatment and pretreatment to 6-month follow-up change scores were tested using randomization-based inference. EXP was superior to TAU in reducing upper extremity disability from pretreatment to posttreatment (between-group difference, 1.082; 95% confidence interval [CI], 0.563-1.601; P < 0.001) and from pretreatment to 6-month follow-up (1.303; 95% CI, 0.917-1.690; P < 0.001). EXP was superior in reducing lower extremity disability from pretreatment to 6-month follow-up (3.624; 95% CI, 0.467-6.781; P = 0.02), but not from pretreatment to posttreatment (3.055; 95% CI, -0.018 to 6.128; P = 0.054). All secondary outcomes significantly favored EXP pretreatment to posttreatment, as well as pretreatment to 6-month follow-up. Exposure to daily activities shows to be more effective than a protective pain-contingent TAU in reducing self-reported disability in daily life of CRPS-I patients with at least moderate levels of pain-related fear.
authors.affiliation: Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands.|Department of Rehabilitation, Maastricht University Medical Center, Maastricht, the Netherlands.|Adelante Centre of Expertise in Rehabilitation, Hoensbroek, the Netherlands.
authors.forename: Marlies
authors.initials: M
authors.lastname: den Hollander
authors.affiliation: Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands.|Department of Rehabilitation Medicine, Maastricht University, CAPHRI-School for Public Health and Primary Care, Maastricht, the Netherlands.
authors.forename: Mariëlle
authors.initials: M
authors.lastname: Goossens
authors.affiliation: Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands.|Department of Rehabilitation Medicine, Maastricht University, CAPHRI-School for Public Health and Primary Care, Maastricht, the Netherlands.|Adelante Centre of Expertise in Rehabilitation, Hoensbroek, the Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: de Jong
authors.affiliation: Department of Rehabilitation Medicine, Maastricht University, CAPHRI-School for Public Health and Primary Care, Maastricht, the Netherlands.
authors.forename: Joop
authors.initials: J
authors.lastname: Ruijgrok
authors.affiliation: Department of Physical Therapy, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Oosterhof
authors.affiliation: Research Group on Methods, Individual and Cultural Differences, Affect and Social Behaviour, KU Leuven-University of Leuven, Leuven, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Onghena
authors.affiliation: Department of Rehabilitation, Maastricht University Medical Center, Maastricht, the Netherlands.|Department of Rehabilitation Medicine, Maastricht University, CAPHRI-School for Public Health and Primary Care, Maastricht, the Netherlands.|Libra Rehabilitation and Audiology, Eindhoven/Weert, the Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Smeets
authors.affiliation: Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands.|Research Group Health Psychology, KU Leuven-University of Leuven, Leuven, Belgium.
authors.forename: Johan W S
authors.initials: JWS
authors.lastname: Vlaeyen
mesh_terms: D000328:Adult; D020918:Complex Regional Pain Syndromes / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D057566:Self Report; D016896:Treatment Outcome