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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?
Our approach to treating CRPS
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’
www.bodyinmind.com.au Copyright GL Moseley 2009
Why train the brain?
CRPS as an extreme protective response.
Cognitive
Understanding the problem
Other threatening cues are relevant
Educate & explain
Behavioural
Function & movement heirarchy
‘training the brain part 1’
Brain changes
S1 reorganisation
Reorganisation elsewhere?
‘training the brain part 2
www.bodyinmind.com.au Copyright GL Moseley 2009
Why train the brain?
CRPS as an extreme protective response.
Cognitive
Understanding the problem
Other threatening cues are relevant
Educate & explain
Behavioural
Function & movement heirarchy
‘training the brain part 1’
Brain changes
S1 reorganisation
Reorganisation elsewhere?
‘training the brain part 2
www.bodyinmind.com.au Copyright GL Moseley 2009
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
www.amazon.com
Maihofner et al 2003 Neurology 61 1707-15
Unaffected side vs affected side
www.bodyinmind.com.au Copyright GL Moseley 2009
Using discrimination of tactile stimuli to restore S1 maps
www.bodyinmind.com.au Copyright GL Moseley 2009
Braun et al, J Neurosci, 2000, 20(1):446-
Stimulation only - representation together
Discriminating between stimuli - representation moves apart
www.bodyinmind.com.au Copyright GL Moseley 2009
Flor et al 2001 Lancet 357 1763-4 RCT
Discriminate location & intensity between stimuli
www.bodyinmind.com.au Copyright GL Moseley 2009
Flor et al 2001 Lancet 357 1763-4 RCT
Discriminate location & intensity between stimuli
www.bodyinmind.com.au Copyright GL Moseley 2009
Flor et al 2001 Lancet 357 1763-4 RCT
Discriminate location & intensity between stimuli
www.bodyinmind.com.au Copyright GL Moseley 2009
Flor et al 2001 Lancet 357 1763-4 RCT
Discriminate location & intensity between stimuli
www.bodyinmind.com.au Copyright GL Moseley 2009
Flor et al 2001 Lancet 357 1763-4 RCT
Discriminate location & intensity between stimuli
www.bodyinmind.com.au Copyright GL Moseley 2009
Flor et al 2001 Lancet 357 1763-4 RCT
Discriminate location & intensity between stimuli
www.bodyinmind.com.au Copyright GL Moseley 2009
Flor et al 2001 Lancet 357 1763-4 RCT
Discriminate location & intensity between stimuli
www.bodyinmind.com.au Copyright GL Moseley 2009
Flor et al 2001 Lancet 357 1763-4 RCT
Discriminate location & intensity between stimuli
www.bodyinmind.com.au Copyright GL Moseley 2009
Flor et al 2001 Lancet 357 1763-4 RCT
Discriminate location & intensity between stimuli
www.bodyinmind.com.au Copyright GL Moseley 2009
Flor et al 2001 Lancet 357 1763-4 RCT
Discriminate location & intensity between stimuli
D
www.bodyinmind.com.au Copyright GL Moseley 2009
Flor et al 2001 Lancet 357 1763-4 RCT
Discriminate location & intensity between stimuli
D
PrePost
Phantom limb pain
6
0
D040
www.bodyinmind.com.au Copyright GL Moseley 2009
Flor et al 2001 Lancet 357 1763-4 RCT
Discriminate location & intensity between stimuli
D
PrePost
Phantom limb pain
6
0
D040
www.bodyinmind.com.au Copyright GL Moseley 2009
Flor et al 2001 Lancet 357 1763-4 RCT
Discriminate location & intensity between stimuli Phantom
limb pain
6
0
D040
PrePost
Change in acuity, pain & representation all
related
Spearman’s >0.73 p <0.05
www.bodyinmind.com.au Copyright GL Moseley 2009
Flor et al 2001 Lancet 357 1763-4 RCT
Discriminate location & intensity between stimuli Phantom
limb pain
6
0
D040
PrePost
Change in acuity, pain & representation all
related
Spearman’s >0.73 p <0.05
www.bodyinmind.com.au Copyright GL Moseley 2009
1 2 34
5
Probes
Stimulation sites
A. Stimulation
2 mm 11 mm
Photograph of affected part, with stimulation sites marked.
Affected part ATTENTION
5
1 2 3451 2 345
1 2 345Screen
NO ATTENTION
Moseley et al 2008 Pain 137(3) 600-8
www.bodyinmind.com.au Copyright GL Moseley 2009
0
5
10
Wait No attention
Attention Review
Task-specificNRS
0
4
8Pain NRS
30
60
TPDmm
ATTENTION
5
1 2 3451 2 345
1 2 345Screen
NO ATTENTION
Moseley et al 2008 Pain 137(3) 600-8
www.bodyinmind.com.au Copyright GL Moseley 2009
Schaefer et al 2005 Neuroimage
www.bodyinmind.com.au Copyright GL Moseley 2009
Taylor-Clarke et al 2002 Curr Biol 12 233-236
www.bodyinmind.com.au Copyright GL Moseley 2009
Mo
sele
y &
Wie
ch
200
9 Pain
144
(3)
314-
9
www.bodyinmind.com.au Copyright GL Moseley 2009
Mo
sele
y &
Wie
ch
200
9 Pain
144
(3)
314-
9
www.bodyinmind.com.au Copyright GL Moseley 2009
Mo
sele
y &
Wie
ch
200
9 Pain
144
(3)
314-
9
Two sessions of this per day for two weeks, reduced pain,
increased tactile acuity and function.
www.bodyinmind.com.au Copyright GL Moseley 2009
Mo
sele
y &
Wie
ch
200
9 Pain
144
(3)
314-
9
www.bodyinmind.com.au Copyright GL Moseley 2009
Mo
sele
y &
Wie
ch
200
9 Pain
144
(3)
314-
9
We hypothesise that one session of this will be better.
www.bodyinmind.com.au Copyright GL Moseley 2009
Mo
sele
y &
Wie
ch
200
9 Pain
144
(3)
314-
9
www.bodyinmind.com.au Copyright GL Moseley 2009
Why train the brain?
Our approach to treating CRPS
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’
www.bodyinmind.com.au Copyright GL Moseley 2009
Why train the brain?
Recent developments
Neglect and ownership
Disrupted bodily awareness
Disruption of high-order cognitive
representations.
www.bodyinmind.com.au Copyright GL Moseley 2009
Go to the next set of slides on Recent Developments
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