Paradoxical discovery in chronic pain research

Fewer limitations after exposure to painful activities

Exposure to painful activities has a positive effect on pain perception in people with the pain syndrome CRSP-1. This effect was demonstrated in a study conducted by psychologist Marlies den Hollander of Maastricht UMC+, expertise centre Pain and Rehabilitation Adelante (Pijn en Revalidatie Adelante) and the University of Leuven. The paradoxical findings were recently published in the leading scientific journal Pain.

Complex regional pain syndrome type I (CRPS-1) formerly known as reflex sympathetic dystrophy, is characterised by pain in the extremities (arms and legs), often following a trauma. This pain is chronic and difficult to treat. Patients with CRPS-1 expect their pain to increase during certain activities, which has a considerable impact on their daily functioning. As a result, they tend to avoid situations that may cause them pain. Most of the limitations these patients experience stem from a fear that their pain will worsen. However, carrying out the activities they fear not only improves their daily functioning and well-being, it also improves the way they perceive pain.

Confronting a fear under supervision is known as exposure. In the study, a group of CRPS-1 patients received treatment that specifically targeted their fear of certain activities. The results of this treatment were compared to another group of CRPS-1 patients with similar symptoms. That group underwent conventional treatment in the form of physiotherapy with minimal activities to avoid pain. The general outcome of the study was determined by self-reported invalidity on behalf of the patients. The researchers also measured pain intensity, concerns and negativity about pain, feelings of helplessness and concerns about the harmfulness of physical activities.

Reduction in symptoms
'The study resulted in the rather paradoxical conclusion that patients should face their pain and fear in order to overcome it,' says Den Hollander. 'Their perceived limitations were reduced by 90% after exposure to the feared activities. In some cases, the effects were even greater six months after treatment compared to immediately after treatment, unlike similar studies in which the effects diminish over time.'

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