Part of training the brain series focused on Complex Regional Pain Syndrome (CRPS) but relevant to all types of pain.

1. Complex Regional Pain
www.bodyinmind.com.au
Copyright GL Moseley 2009
Syndrome
CRPS Rehabilitation
(or training the brain)
Lorimer Moseley
NHMRC Senior Research Fellow
Prince of Wales Medical Research Institute & Faculty of Medicine, University of NSW, Sydney,
Australia

2. www.bodyinmind.com.au
Copyright GL Moseley 2009
Why train the brain?
CRPS as an extreme protective response.

3. www.bodyinmind.com.au
Copyright GL Moseley 2009
Why train the brain?
Our approach to treating CRPS
Cognitive Behavioural Brain changes
Understanding the Function & S1 reorganisation
problem movement
hierarchy Reorganisation
Other threatening elsewhere?
cues are relevant ‘training the brain
part 1’ ‘training the brain
Educate & explain part 2’

4. www.bodyinmind.com.au
Copyright GL Moseley 2009
Why train the brain?
CRPS as an extreme protective response.
Cognitive Behavioural Brain changes
Understanding the Function & S1 reorganisation
problem movement
heirarchy Reorganisation
Other threatening elsewhere?
cues are relevant ‘training the brain
part 1’ ‘training the brain
Educate & explain part 2

5. www.bodyinmind.com.au
Copyright GL Moseley 2009
Why train the brain?
CRPS as an extreme protective response.
Cognitive Behavioural Brain changes
Understanding the Function & S1 reorganisation
problem movement
heirarchy Reorganisation
Other threatening elsewhere?
cues are relevant ‘training the brain
part 1’ ‘training the brain
Educate & explain part 2

6. resources
DAVID BUTLER
|
LORIMER MOSELEY
|
ART SUNYATA
www.noigroup.com
www.physiouk.co.uk
www.OPTP.com
www.noigroup.com
www.OPTP.com
www.physiouk.co.uk
www.amazon.com

7. www.bodyinmind.com.au
Copyright GL Moseley 2009
Unaffected side vs affected side
Maihofner et al 2003 Neurology 61 1707-15

8. www.bodyinmind.com.au
Copyright GL Moseley 2009
Using discrimination of tactile stimuli to
restore S1 maps

9. www.bodyinmind.com.au
Copyright GL Moseley 2009
Stimulation only - representation
together
Discriminating between stimuli -
representation moves apart
Braun et al, J Neurosci, 2000, 20(1):446-

10. www.bodyinmind.com.au
Copyright2001 Lancet 357 1763-4
Flor et al GL Moseley 2009 RCT
Discriminate location &
intensity between stimuli

11. www.bodyinmind.com.au
Copyright2001 Lancet 357 1763-4
Flor et al GL Moseley 2009 RCT
Discriminate location &
intensity between stimuli

12. www.bodyinmind.com.au
Copyright2001 Lancet 357 1763-4
Flor et al GL Moseley 2009 RCT
Discriminate location &
intensity between stimuli

13. www.bodyinmind.com.au
Copyright2001 Lancet 357 1763-4
Flor et al GL Moseley 2009 RCT
Discriminate location &
intensity between stimuli

14. www.bodyinmind.com.au
Copyright2001 Lancet 357 1763-4
Flor et al GL Moseley 2009 RCT
Discriminate location &
intensity between stimuli

15. www.bodyinmind.com.au
Copyright2001 Lancet 357 1763-4
Flor et al GL Moseley 2009 RCT
Discriminate location &
intensity between stimuli

16. www.bodyinmind.com.au
Copyright2001 Lancet 357 1763-4
Flor et al GL Moseley 2009 RCT
Discriminate location &
intensity between stimuli

17. www.bodyinmind.com.au
Copyright2001 Lancet 357 1763-4
Flor et al GL Moseley 2009 RCT
Discriminate location &
intensity between stimuli

18. www.bodyinmind.com.au
Copyright2001 Lancet 357 1763-4
Flor et al GL Moseley 2009 RCT
Discriminate location &
intensity between stimuli

19. www.bodyinmind.com.au
Copyright2001 Lancet 357 1763-4
Flor et al GL Moseley 2009 RCT
Discriminate location &
intensity between stimuli
D

20. www.bodyinmind.com.au
Copyright2001 Lancet 357 1763-4
Flor et al GL Moseley 2009 RCT
6
Discriminate location &
intensity between stimuli Phantom
limb pain
Pre
Post
0
40 0
D
D

21. www.bodyinmind.com.au
Copyright2001 Lancet 357 1763-4
Flor et al GL Moseley 2009 RCT
6
Discriminate location &
intensity between stimuli Phantom
limb pain
Pre
Post
0
40 0
D
D

22. www.bodyinmind.com.au
Flor et al 2001 Lancet 357 1763-4 RCT
Copyright GL Moseley 2009
6
Discriminate location &
intensity between stimuli Phantom
limb pain
Pre
Post
0
40 0
D
Change in acuity, pain
& representation all
related
Spearman’s >0.73
p <0.05

23. www.bodyinmind.com.au
Flor et al 2001 Lancet 357 1763-4 RCT
Copyright GL Moseley 2009
6
Discriminate location &
intensity between stimuli Phantom
limb pain
Pre
Post
0
40 0
D
Change in acuity, pain
& representation all
related
Spearman’s >0.73
p <0.05

24. A. Stimulation
www.bodyinmind.com.au
Copyright GL Moseley 2009
NO ATTENTION
Probes
Screen
5
1 2 34
2 mm 11 mm
Affected part ATTENTION
Stimulation
sites
5
1 2 4
3 5
5 5
1 2 34 1 2 34
Photograph of affected part,
with stimulation2008 Pain 137(3) 600-8
Moseley et al sites marked.

25. www.bodyinmind.com.au
Copyright 8 Moseley 2009
GL NO ATTENTIO
Pain NRS
4
Screen
5
0 1 2 34
60
TPD
mm
ATTENTION
30
10
Task-specific
NRS
5
5 5 5
1 2 34 1 2 34
0 Wait No Attention Review
attention
Moseley et al 2008 Pain 137(3) 600-8

26. www.bodyinmind.com.au
Copyright GL Moseley 2009
Schaefer et al 2005 Neuroimage

27. www.bodyinmind.com.au
Copyright GL Moseley 2009
Taylor-Clarke et al 2002 Curr Biol 12 233-236

28. www.bodyinmind.com.au
Copyright GL Moseley 2009
Moseley & Wiech 2009 Pain 144(3) 314-9

29. www.bodyinmind.com.au
Copyright GL Moseley 2009
Moseley & Wiech 2009 Pain 144(3) 314-9

30. www.bodyinmind.com.au
Copyright GL Moseley 2009
Moseley & Wiech 2009 Pain 144(3) 314-9
Two sessions of this per day for
two weeks, reduced pain,
increased tactile acuity and
function.

31. www.bodyinmind.com.au
Copyright GL Moseley 2009
Moseley & Wiech 2009 Pain 144(3) 314-9

32. www.bodyinmind.com.au
Copyright GL Moseley 2009
We hypothesise that one session
of this will be better.
Moseley & Wiech 2009 Pain 144(3) 314-9

33. www.bodyinmind.com.au
Copyright GL Moseley 2009
Moseley & Wiech 2009 Pain 144(3) 314-9

34. www.bodyinmind.com.au
Copyright GL Moseley 2009
Why train the brain?
Our approach to treating CRPS
Cognitive Behavioural Brain changes
Understanding the Function & S1 reorganisation
problem movement
hierarchy Reorganisation
Other threatening elsewhere?
cues are relevant ‘training the brain
part 1’ ‘training the brain
Educate & explain part 2’

35. www.bodyinmind.com.au
Copyright GL Moseley 2009
Why train the brain?
Recent developments
Go to the next Neglect and
ownership
Disrupted bodily
awareness
set of slides on Disruption of
Recent high-order
cognitive
Developments representations.