Pain reduction by inducing sensory-motor adaptation: CRPS PRISMA trial

Monika Halicka

Research output: Contribution to conferenceAbstractpeer-review


Background & Aims. People with Complex Regional Pain Syndrome (CRPS) experience persisting pain, sensory hypersensitivity, motor difficulties, and autonomic and trophic changes in one or more limb(s). They also present with changes in perception of and attention to the affected body part and surrounding space. It has been suggested that the discrepancy between sensory and motor representations of the body and space may cause the physical symptoms of CRPS. A sensory-motor training method called prism adaptation (PA) has been previously shown to alleviate pain and other symptoms of CRPS. Although promising, this evidence comes from few unblinded, uncontrolled, small sample studies. Therefore, our clinical trial sets out to test the effects of PA treatment on the CRPS symptoms. We further aim to investigate how neuropsychological changes in spatial attention and body representation pertain to clinical manifestations of CRPS. The final purpose is to identify possible predictors of the course of the disease and response to treatment. Methods. This randomized, double-blind, placebo-controlled trail will enroll 42 upper-limb CRPS type I patients (meeting the Budapest diagnostic criteria) and 21 matched controls for comparative baseline data. The patients will undergo 2 weeks of twice-daily real or sham prism adaptation. Pain intensity is the primary outcome measure. Secondary outcome measures include the results of self-report questionnaires, clinical assessments, and psychophysical and computer-based tests of physical and neuropsychological symptoms. Data will be collected 4 weeks prior to treatment, immediately before and after treatment, and 4 weeks post-treatment. During that time, the patients will record daily ratings of pain, range of motion and symptoms interference. Long-term follow up will be carried out 3 and 6 months post-treatment through postal questionnaires. Ethical approval has been granted by the Oxford A Research Ethics Committee (ref. 12/sc/0667). Results. We expect more pronounced alterations in perception of and attention to the affected limb to be associated with more severe physical symptoms of CRPS. We further predict greater reduction in CRPS symptoms in the group undergoing real PA, compared to the group receiving sham treatment. We will also explore which baseline and outcome measures may account for individual differences in CRPS progression and response to treatment. Conclusion. These findings might yield better recognition of the role that neuropsychological changes play in the manifestation and treatment of CRPS symptoms. Furthermore, this study will allow a reliable evaluation of the immediate and long-term effects of PA. Assuming that PA proves to be effective in reducing pain and other CRPS symptoms, that evidence would support introducing PA as simple, time- and cost-effective, non-invasive rehabilitation method for CRPS. Funded by the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA)
Original languageEnglish
Publication statusPublished - 4 Jun 2017
EventEuropean Pain School - Siena, Italy
Duration: 4 Jun 201611 Jun 2016


OtherEuropean Pain School
Internet address


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