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Part of training the brain series focused on Complex Regional Pain Syndrome (CRPS) but relevant to all types of pain.
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Lorimer MoseleyNHMRC Senior Research FellowPrince of Wales Medical Research Institute & Faculty of Medicine, University of NSW, Sydney, Australia
CRPS Rehabilitation (or training the brain)
www.bodyinmind.com.au Copyright GL Moseley 2009 Complex Regional Pain
Syndrome
Why train the brain?
CRPS as an extreme protective response.
www.bodyinmind.com.au Copyright GL Moseley 2009
Why train the brain?
Cognitive
Understanding the problem
Other threatening cues are relevant
Educate & explain
Behavioural
Function & movement hierarchy
‘training the brain part 1’
Brain changes
S1 reorganisation
Reorganisation elsewhere?
‘training the brain part 2’
Recent developments
Neglect and ownership
Disrupted bodily awareness
Disruption of high-order cognitive
representations.
www.bodyinmind.com.au Copyright GL Moseley 2009
Our approach to treating CRPS
Why train the brain?
Disrupted bodily awareness
Disruption of high-order cognitive
representations.
www.bodyinmind.com.au Copyright GL Moseley 2009
Recent developments
Experiment: Do patients with CRPS actually think their
affected limb is bigger than it is?
Moseley 2004 Neurology 65
www.bodyinmind.com.au Copyright GL Moseley 2009
32 CRPS patients 18 non-CRPS chronic hand pain patients
Digital photo
affected
www.bodyinmind.com.au Copyright GL Moseley 2009
32 CRPS patients 18 non-CRPS chronic hand pain patients
affected
Expanded or condensed
www.bodyinmind.com.au Copyright GL Moseley 2009
32 CRPS patients 18 non-CRPS chronic hand pain patients
affected
Expanded to 115%
www.bodyinmind.com.au Copyright GL Moseley 2009
32 CRPS patients 18 non-CRPS chronic hand pain patients
affected
Condensed to 85%
www.bodyinmind.com.au Copyright GL Moseley 2009
“Which of these is a true picture?”
www.bodyinmind.com.au Copyright GL Moseley 2009
“Which of these are chicken feet?”
www.bodyinmind.com.au Copyright GL Moseley 2009
Proportion of sample
50%
0%90% 95% 100% 105% 110% 115%
Size of affected limb as a proportion of true size
85%
Normal controls
Moseley 2004 Neurology 65, 773
www.bodyinmind.com.au Copyright GL Moseley 2009
Proportion of sample
50%
0%90% 95% 100% 105% 110% 115%
Size of affected limb as a proportion of true size
85%
Normal controlsPatients with non-CRPS1 pain
Moseley 2004 Neurology 65, 773
www.bodyinmind.com.au Copyright GL Moseley 2009
Proportion of sample
50%
0%90% 95% 100% 105% 110% 115%
Size of affected limb as a proportion of true size
Patients with CRPS1
85%
Normal controlsPatients with non-CRPS1 pain
Moseley 2004 Neurology 65, 773
www.bodyinmind.com.au Copyright GL Moseley 2009
Proportion of sample
50%
0%90% 95% 100% 105% 110% 115%
Size of affected limb as a proportion of true size
Patients with CRPS1
85%
Normal controlsPatients with non-CRPS1 pain
Moseley 2004 Neurology 65, 773
www.bodyinmind.com.au Copyright GL Moseley 2009
Why might that be?
This also happens after anaesthetic
www.bodyinmind.com.au Copyright GL Moseley 2009
www.bodyinmind.com.au Copyright GL Moseley 2009
www.bodyinmind.com.au Copyright GL Moseley 2009
Could distorted body image be contributing
to symptoms?
www.bodyinmind.com.au Copyright GL Moseley 2009
Design
10 patients with CRPS of one hand Random allocation
Control Clear Magnified Minified
www.bodyinmind.com.au Copyright GL Moseley 2009
Moseley, Parsons & Spence 2008 Current Biology 18, 1047-8
www.bodyinmind.com.au Copyright GL Moseley 2009
0
40
10 200
Change in pain
(100 mm VAS)
M R
Trial time (minutes)
Control
www.bodyinmind.com.au Copyright GL Moseley 2009
0
40
10 200
Change in pain
(100 mm VAS)
M R
Trial time (minutes)
Control Clear
www.bodyinmind.com.au Copyright GL Moseley 2009
0
40
10 200
Change in pain
(100 mm VAS)
M R
Trial time (minutes)
Control Clear Magnified
www.bodyinmind.com.au Copyright GL Moseley 2009
0
100
Peak pain(100 mm
VAS)
Ctrl Clear Mag.Recovery time (minutes)
200
*
*
Ctrl
Clear
Mag.
A B
0.8
1.2
Post-task swelling(aff/unaff)
*
Control Clear Magnified
* *
*
www.bodyinmind.com.au Copyright GL Moseley 2009
Moseley, Parsons & Spence 2008 Current Biology 18, 1047-8
Why train the brain?
Cognitive
Understanding the problem
Other threatening cues are relevant
Educate & explain
Behavioural
Function & movement hierarchy
‘training the brain part 1’
Brain changes
S1 reorganisation
Reorganisation elsewhere?
‘training the brain part 2’
Recent developments
Neglect and ownership
Disrupted bodily awareness
Disruption of high-order cognitive
representations.
www.bodyinmind.com.au Copyright GL Moseley 2009
Our approach to treating CRPS
DAVID
BUTLER | LO
RIMER M
OSELEY | ART SU
NYATA
www.noigroup.comwww.OPTP.comwww.physiouk.co.uk
www.noigroup.comwww.physiouk.co.uk
www.OPTP.com
resources
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