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Randomized Controlled Trial
. 2015 Apr 28;10(4):e0123008.
doi: 10.1371/journal.pone.0123008. eCollection 2014.

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

Karlijn J Barnhoorn  1 , J Bart Staal  1 , Robert T M van Dongen  2 , Jan Paul M Frölke  3 , Frank P Klomp  4 , Henk van de Meent  5 , Han Samwel  6 , Maria W G Nijhuis-van der Sanden  7
Affiliations
Randomized Controlled Trial

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

Karlijn J Barnhoorn et al. PLoS One. .

Abstract

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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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The fear-avoidance model, showing the targets of Pain Exposure Physical Therapy and graded exposure treatment.
In this model, pain catastrophizing, pain-related fear and avoidance are thought to be mediators for the treatment of disability and consequently pain. Reproduced from Vlaeyen and Linton [7]. PEPT = Pain Exposure Physical Therapy. GEXP = Graded Exposure treatment.
Fig 2
Fig 2. Model for the mediation analysis.
This model was used to analyse potential mediation between the independent variable (Pain Exposure Physical Therapy versus conventional treatment), the mediator variable (fear-avoidance beliefs or pain catastrophizing or kinesiophobia), and the dependent variable (pain-related disability or pain) [30]. PEPT = Pain Exposure Physical Therapy. CONV = conventional treatment.
Fig 3
Fig 3. Outcomes for both treatment groups at baseline and at 3, 6, and 9 months follow-up.
Panel A: dependent variables pain-related disability and pain. Panel B: potential mediators fear-avoidance beliefs, pain catastrophizing, and kinesiophobia. PDI = Pain Disability Index. VAS = Visual Analogue Scale. FABQ = Fear-Avoidance Beliefs Questionnaire. PCS = Pain Catastrophizing Scale. TSK = Tampa Scale for Kinesiophobia. CONV = conventional treatment. PEPT = Pain Exposure Physical Therapy.
See this image and copyright information in PMC

References

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