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
Recent developments
Cognitive Behavioural Brain Neglect and Disrupted bodily
Understanding Function & changes ownership awareness
the problem movement
S1 reorganisation
hierarchy Disruption of
Other
threatening ‘training the brain Reorganisation high-order
elsewhere?
cues are part 1’ cognitive
relevant
‘training the brain representations.
Educate & part 2’
explain

4. www.bodyinmind.com.au
Copyright GL Moseley 2009
Why train the brain?
Recent developments
Disrupted bodily
awareness
Disruption of
high-order
cognitive
representations.

5. www.bodyinmind.com.au
Copyright GL Moseley 2009
Experiment: Do patients with
CRPS actually think their
affected limb is bigger than it
is?
Moseley 2004 Neurology 65

6. www.bodyinmind.com.au
Copyright GL Moseley 2009
32 CRPS patients 18 non-CRPS chronic
hand pain patients
Digital photo
affected

7. www.bodyinmind.com.au
Copyright GL Moseley 2009
32 CRPS patients 18 non-CRPS chronic
hand pain patients
Expanded or condensed
affected

8. www.bodyinmind.com.au
Copyright GL Moseley 2009
32 CRPS patients 18 non-CRPS chronic
hand pain patients
Expanded to 115%
affected

9. www.bodyinmind.com.au
Copyright GL Moseley 2009
32 CRPS patients 18 non-CRPS chronic
hand pain patients
Condensed to 85%
affected

10. www.bodyinmind.com.au
Copyright GL Moseley 2009
“Which of these is a true
picture?”

11. www.bodyinmind.com.au
Copyright GL Moseley 2009
“Which of these are chicken
feet?”

12. www.bodyinmind.com.au
Copyright GL Moseley 2009
Normal controls
50%
Proportion
of sample
0%
85% 90% 95% 100% 105% 110% 115%
Size of affected limb as a proportion of true size
Moseley 2004 Neurology 65, 773

13. www.bodyinmind.com.au
Copyright GL Moseley 2009
Normal controls
Patients with non-CRPS1 pain
50%
Proportion
of sample
0%
85% 90% 95% 100% 105% 110% 115%
Size of affected limb as a proportion of true size
Moseley 2004 Neurology 65, 773

14. www.bodyinmind.com.au
Copyright GL Moseley 2009
Normal controls
Patients with non-CRPS1 pain
50%
Patients with CRPS1
Proportion
of sample
0%
85% 90% 95% 100% 105% 110% 115%
Size of affected limb as a proportion of true size
Moseley 2004 Neurology 65, 773

15. www.bodyinmind.com.au
Copyright GL Moseley 2009
Normal controls
Patients with non-CRPS1 pain
50%
Patients with CRPS1
Proportion
of sample
0%
85% 90% 95% 100% 105% 110% 115%
Size of affected limb as a proportion of true size
Moseley 2004 Neurology 65, 773

16. www.bodyinmind.com.au
Copyright GL Moseley 2009
Why might that be?
This also happens after anaesthetic

17. www.bodyinmind.com.au
Copyright GL Moseley 2009

18. www.bodyinmind.com.au
Copyright GL Moseley 2009

19. www.bodyinmind.com.au
Copyright GL Moseley 2009
Could distorted body
image be contributing
to symptoms?

20. www.bodyinmind.com.au Design
Copyright GL Moseley 2009
10 patients with CRPS of one hand
Random allocation
Control Clear Magnified Minified

21. www.bodyinmind.com.au
Copyright GL Moseley 2009
Moseley, Parsons & Spence 2008 Current Biology 18, 1047-8

22. www.bodyinmind.com.au
Copyright GL Moseley 2009
Control
40
Change in
pain
(100 mm
VAS)
M R
0
0 10 20
Trial time (minutes)

23. www.bodyinmind.com.au
Copyright GL Moseley 2009
Control Clear
40
Change in
pain
(100 mm
VAS)
M R
0
0 10 20
Trial time (minutes)

24. www.bodyinmind.com.au
Copyright GL Moseley 2009
Control Clear Magnified
40
Change in
pain
(100 mm
VAS)
M R
0
0 10 20
Trial time (minutes)

25. Awww.bodyinmind.com.au
Copyright GL Moseley 2009
100 *** 1.2
B
*
Peak pain Post- Mag.
(100 mm task *
VAS) swelling *
Clear
(aff/unaff)
Ctrl
0 Ctrl Clear Mag. 0.8 0 20
Recovery time (minutes)
Control Clear Magnified
Moseley, Parsons & Spence 2008 Current Biology 18, 1047-8

26. www.bodyinmind.com.au
Copyright GL Moseley 2009
Why train the brain?
Our approach to treating CRPS
Recent developments
Cognitive Behavioural Brain Neglect and Disrupted bodily
Understanding Function & changes ownership awareness
the problem movement
S1 reorganisation
hierarchy Disruption of
Other
threatening ‘training the brain Reorganisation high-order
elsewhere?
cues are part 1’ cognitive
relevant
‘training the brain representations.
Educate & part 2’
explain

27. 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