Abstract
Numerous studies have shown that pain-related fear is one of the strongest predictors
of pain disability in patients with chronic musculoskeletal pain, and there is evidence
that the reduction of pain-related fear through an exposure treatment can be associated
with restoration of functional abilities in patients with complex regional pain syndrome
type I (CRPS-I). These findings suggest that pain-related fear may be associated with
functional limitations in neuropathic pain as well. The aim of the current study was
to test whether the debilitating role of pain-related fear generalizes to patients
with CRPS-I. The results of 2 studies are presented. Study I includes a sample of
patients with early CRPS-I referred to an outpatient pain clinic. In Study II, patients
with chronic CRPS who are members of a patients’ association were invited to participate.
The results show that in early CRPS-I, pain severity but not fear of movement/(re)injury
as measured with the Tampa Scale for Kinesiophobia was related to functional limitations.
In patients with chronic CRPS-I, however, perceived harmfulness of activities as measured
with the pictorial assessment method significantly predicted functional limitations
beyond and above the contribution of pain severity. Not fear of movement/(re)injury
in general, but the perceived harmfulness of activities appears a key factor that
might be addressed more systematically in the clinical assessment of patients with
CRPS-I. These results support the idea that pain-related fear might be a promising
concept in the understanding of pain disability in patients with neuropathic pain.
Perspective
This is the first study showing that perceived harmfulness of activities contribute
to the functional limitations in CRPS-I. The current findings may help clinicians
customizing cognitive-behavioral treatments for patients with chronic neuropathic
pain.
Key words
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Article info
Publication history
Published online: October 28, 2011
Accepted:
June 17,
2011
Received in revised form:
June 1,
2011
Received:
June 3,
2010
Footnotes
Supported by the Esperance Foundation, affiliated to the Dutch association for Patients of Post-Traumatic Dystrophy (Nederlandse Vereniging van Posttraumatische Dystrofie Patienten) and the Department of Pain Management and Research of the University Hospital Maastricht. Participation of J.W.S. Vlaeyen was supported by the NWO Social Sciences Research Council of the Netherlands, VICI Grant No. 453-04-003, and an Odysseus Grant by the Fund for Scientific Research (FWO) Flanders, Belgium.
The authors have no conflicts of interest to report.
Identification
Copyright
© 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.
