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| 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 |
| Barnhoorn KJ, Staal JB, van Dongen RTM, Frolke JPM, Klomp FP, van de Meent H, Samwel H, Nijhuis-van der Sanden MWG |
| PLoS ONE 2015 Apr;10(4):e0123008 |
| clinical trial |
| 5/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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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. DESIGN: An explorative secondary analysis of a randomised controlled trial. PARTICIPANTS: Fifty-six patients with complex regional pain syndrome type 1. INTERVENTIONS: 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. OUTCOME MEASURES: 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. CONCLUSION: 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. TRIAL REGISTRATION: International Clinical Trials Registry NCT00817128.
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