• Marlies den Hollander, Mariëlle Goossens, Jeroen de Jong, Joop Ruijgrok, Jan Oosterhof, Patrick Onghena, Rob Smeets, and Johan W S Vlaeyen.
• aDepartment of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands bDepartment of Rehabilitation, Maastricht University Medical Center, Maastricht, the Netherlands cDepartment of Rehabilitation Medicine, Maastricht University, CAPHRI-School for Public Health and Primary Care, Maastricht, the Netherlands dDepartment of Physical Therapy, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands eResearch Group on Methods, Individual and Cultural Differences, Affect and Social Behaviour, KU Leuven-University of Leuven, Leuven, Belgium fAdelante Centre of Expertise in Rehabilitation, Hoensbroek, the Netherlands gResearch Group Health Psychology, KU Leuven-University of Leuven, Leuven, Belgium hLibra Rehabilitation and Audiology, Eindhoven/Weert, the Netherlands.
• Pain. 2016 Oct 1; 157 (10): 2318-29.

AbstractComplex 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.

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