Virtual reality in managing Complex Regional Pain Syndrome (CRPS): a scoping review.

Background: Complex Regional Pain Syndrome (CRPS) is a severe pain disorder that does not yet have a specific treatment. Patients with CRPS not only suffer from a wide range of symptoms that affect their quality of life but also present psychological affections to the way they see their body and specifically their affected limb. Virtual Reality (VR) modalities have become a targeted treatment for chronic pain and in the case of CRPS, may be a valuable approach to the mechanisms that affect these patients. Objectives: Using the PRISMA Scoping Review guidelines, we intend to uncover the key information from the studies available about VR modalities in the treatment of CRPS. We focus on the improvement of pain levels, body perception disturbances (BPD), and limb movement/daily function. Results: Our search strategy resulted in 217 articles from PubMed. Twenty were assessed for eligibility and seven were included in the final qualitative synthesis. Of these seven articles, we included a clinical trial, three pilot studies, a blinded randomized controlled trial, a crossover double-blind trial, and a randomized controlled trial. These studies provide important subjective patient findings, along with some statistically significant results in the experiences of VR therapies modulating pain, BPD, and improving limb movement/daily function. However, not all the studies included statistical analysis, and there are contradicting data found from some patients that did not perceive any improvement from VR therapies. Conclusions: We describe the results found in 7 articles that focus on the treatment of CRPS with VR modalities. Overall, the articles have various limitations, but the strategies related to immersive virtual reality, cardiac signaling, body switching and limb modulation have shown the most promising results for pain reduction and BPD improvement. These strategies reflect on pathophysiological mechanisms that are hypothesized to be affected in CRPS patients leading to the chronic pain and BPD that they experience. Not much evidence was found for improvement in limb movement and daily function. This review is a pathway for future studies on this topic and a more extensive data synthesis when more information is available.

Resistance Training Combined with Balance or Gait Training for Patients with Parkinson's Disease: A Randomized Controlled Pilot Study.

Background: Gait and balance disorders in patients with idiopathic Parkinson's disease (PD) lead to major mobility limitations. To counteract this, physical therapy such as gait, balance, or resistance training is applied. Integrative training methods, which combine these elements, could be particularly effective. Objective: The objective of this study is to evaluate and compare the effects of two integrative interventions on gait and balance of patients with PD. Methods: Twenty-six patients with PD received either resistance training in combination with gait training (gait resistance training, GRT) or resistance training in combination with balance training (stability resistance training, SRT) for six weeks. Gait and balance outcome parameters were assessed before, immediately after, and six weeks after the interventions. The primary outcome parameters were the functional reach test to evaluate balance and stride length to evaluate gait. Secondary outcomes included further gait analysis parameters, knee extension strength, the timed up and go test, and the six-minute walk test. Results: The functional reach test results were significantly better after the intervention in both groups. Stride length increased significantly only in the GRT group. Several further gait parameters and the six-minute walk test improved in the GRT group, and the increase in gait speed was significantly higher than in the SRT group. The SRT group performed better after the intervention regarding the timed up and go test and knee extension strength, the latter being significantly more improved than in the SRT group. At six-week follow-up, the improvement in functional reach was maintained in the SRT group. Conclusions: Integrative therapies, combining gait or balance training with resistance training, have specific positive effects in PD rehabilitation. More pronounced effects on gait parameters are achieved by GRT, while SRT has more impact on balance. Thus, the combination of both training methods might be particularly efficient in improving the mobility of PD patients.

[Physical therapy in the treatment of complex regional pain syndrome]. / Physikalische Therapie in der Behandlung des komplexen regionalen Schmerzsyndroms.

The treatment of patients with complex regional pain syndrome (CRPS) takes place in an interdisciplinary and multimodal setting. Physical therapies represent a major treatment focus along with physiotherapy, occupational therapy, and analgetic treatments. This review explains their importance in current clinical practice and gives an impression of the evidence on different treatments including electrotherapy, neuromodulating procedures, manual lymphatic drainage, CO2 applications and paraffin wax baths. As far as ascertainable from clinical experience and the scientific literature, treatment recommendations are presented in accordance with current guidelines.

[Occupational therapy for complex regional pain syndrome]. / Ergotherapie bei komplexem regionalem Schmerzsyndrom.

Occupational therapy, as a rehabilitative treatment is an essential part of multimodal therapy for complex regional pain syndrome (CRPS). The goals of the treatment and the methods vary greatly for this condition, because they are subject to the changing symptomatology. In some cases there are overlapping and synergistic treatment strategies with physiotherapy. For a positive treatment result it is important to implement occupational therapy early on and continuously during the course of the disease. This allows treatment methods, such as mental exercises or sensory exercises to improve the processing of pain-triggering perceptual stimuli at an early stage. Alongside the classical movement exercises and advice on aids, special treatment methods, such as mirror therapy, neurocognitive rehabilitation according to Perfetti or the graded exposure concept can also be beneficial for CRPS patients.

Pain Phenotypes in Rare Musculoskeletal and Neuromuscular Diseases.

For patients diagnosed with a rare musculoskeletal or neuromuscular disease, pain may transition from acute to chronic; the latter yielding additional challenges for both patients and care providers. We assessed the present understanding of pain across a set of ten rare, noninfectious, noncancerous disorders; Osteogenesis Imperfecta, Ehlers-Danlos Syndrome, Achondroplasia, Fibrodysplasia Ossificans Progressiva, Fibrous Dysplasia/McCune-Albright Syndrome, Complex Regional Pain Syndrome, Duchenne Muscular Dystrophy, Infantile- and Late-Onset Pompe disease, Charcot-Marie-Tooth Disease, and Amyotrophic Lateral Sclerosis. Through the integration of natural history, cross-sectional, retrospective, clinical trials, & case studies we described pathologic and genetic factors, pain sources, phenotypes, and lastly, existing therapeutic approaches. We highlight that while rare diseases possess distinct core pathologic features, there are a number of shared pain phenotypes and mechanisms that may be prospectively examined and therapeutically targeted in a parallel manner. Finally, we describe clinical and research approaches that may facilitate more accurate diagnosis, monitoring, and treatment of pain as well as elucidation of the evolving nature of pain phenotypes in rare musculoskeletal or neuromuscular illnesses.

[Exergames for patients with complex regional pain syndrome : A feasibility study]. / Exergames für Patienten mit komplexem regionalem Schmerzsyndrom : Eine Machbarkeitsstudie.

BACKGROUND: Complex regional pain syndrome (CRPS) is a disease of the limbs composed of various disorders and defined by the cardinal symptom of pain. So-called exergames with a combination of physical activity and fun are increasingly being offered as part of treatment. Exergame therapy could also provide CRPS patients with repetitive training, reward and motivation. METHOD: In this study 10 adult patients with CRPS of the hand (50% acute) received a 30 min therapy session using MindMotion™GO. MindMotion™GO is a software that enables control of the integrated games through visual feedback. Outcomes were the subjectively perceived workload (National Aeronautics and Space Administration-task load index, NASA-TLX), user-friendliness (system usability scale, SUS) and pain (numeric rating scale, NRS). RESULTS: The CRPS patients rated the average workload as appropriate with a total score of 50.9 points (SD ± 18.13). The user-friendliness of the system was judged to be acceptable with an average total score of 89.5 ± 7.53 points. There were no significant changes in pain intensity after the exergames. The subgroup analysis (acute versus chronic) showed differences in the assessment of the individual dimensions of the workload. CONCLUSION: In this study the use of exergames proved to be a suitable tool for rehabilitation of the hand in adult CRPS patients. Whether exergames represent an effective rehabilitation strategy should be examined by means of functional and activity-related target criteria in a representative sample in a randomized controlled study.

Implications of the putamen in pain and motor deficits in complex regional pain syndrome.

Complex regional pain syndrome (CRPS) develops after-limb injury, with persistent pain and deficits in movement frequently co-occurring. The striatum is critical for mediating multiple mechanisms that are often aberrant in CRPS, which includes sensory and pain processing, motor function, and goal-directed behaviors associated with movement. Yet, much remains unknown with regards to the morphological and functional properties of the striatum and its subregions in this disease. Thus, we investigated 20 patients (15 female, age 58 ± 9 years, right-handed) diagnosed with chronic (6+ months of pain duration) CRPS in the right hand and 20 matched, healthy controls with anatomical and resting-state, functional magnetic resonance imaging. In addition, a comprehensive clinical and behavioral evaluation was performed, where each participant's pain, motor function, and medical history were assessed. Complex regional pain syndrome patients harbored significant abnormalities in hand coordination, dexterity, and strength. These clinical pain- and movement-related findings in CRPS patients were concomitant with bilateral decreases in gray matter density in the putamen as well as functional connectivity increases and decreases among the putamen and pre-/postcentral gyri and cerebellum, respectively. Importantly, higher levels of clinical pain and motor impairment were associated with increased putamen-pre-/postcentral gyri functional connectivity strengths. Collectively, these findings suggest that putaminal alterations, specifically the functional interactions with sensorimotor structures, may underpin clinical pain and motor impairment in chronic CRPS patients.