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

1. Complex Regional Pain
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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

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Copyright GL Moseley 2009
Why train the brain?
CRPS as an extreme protective response.

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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

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Copyright GL Moseley 2009
Why train the brain?
Recent developments
Neglect and
ownership

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Copyright GL Moseley 2009
Does it feel like it is mine?
Many patients report feelings of
foreigness & hostility towards the
limb.
“I feel like it is not mine, like it is an
imposter”
Lewis et al 2008 Pain

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Could this ‘disownership’ contribute to
symptoms?

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The rubber hand
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illusion
Moseley et al 2008 PNAS 105(35), 13169-73

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The rubber hand
Copyright GL Moseley 2009 Ctl RHI Ctl
illusion 10
Vividness
of RHI
0
0º
Moseley et al 2008 PNAS 105(35), 13169-73
Foot
temperature
-1º
60 s
0º
Hand
temperature
-1º

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10
Moseley et al 2008 PNAS 105(35), 13169-73
33.0
32.0
Control Rubber hand illusion

10. Pre
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Copyright GL Moseley 2009 Post
10
Moseley et al 2008 PNAS 105(35), 13169-73
33.0
32.0
Control Rubber hand illusion
www.bodyinmind.com.au

11. Pre
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Copyright GL Moseley 2009 Post
10
Moseley et al 2008 PNAS 105(35), 13169-73
30.5
Synchronous
tapping eyes
closed RHI
29.5
0 2 Time 5

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Copyright GL Moseley 2009
0º
Skin
temperature
Moseley et al 2008 PNAS 105(35), 13169-73
-1º R =0.50*
0 5 10
Vividness of the illusion
10

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Yes.
Could this ‘disownership’ contribute to
symptoms?

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The neglect question...

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Vibrator

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Vibrator

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Vibrator

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Vibrator

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Stimulator

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Stimulator

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Left
Stimulator

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Stimulator

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Stimulator

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Right
Stimulator

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Copyright GL Moseley 2009
In chronic CRPS,
you have to
stimulate the
affected hand
about 25ms
before the other
to think the
stimuli occurred
at the same
time
Moseley et al 2009 Brain (published on-line 150909)

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Copyright GL Moseley 2009
But when you
cross your arms,
the opposite
occurs - you
have to
stimulate the
UNaffected
20ms before the
affected to
think the stimuli
occurred at the
same time
Moseley et al 2009 Brain (published on-line 150909)

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Copyright GL Moseley 2009
This shows that the
bigger the shift in
processing, the
colder the limb is,
relative to the
opposite one.
The shift away from the affected limb is opposite to what we see
with acute threatening stimuli Van Damme et al 2009 Brain Res.
2009;1253:100-106.
Moseley et al 2009 Brain (published on-line 150909)

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Copyright GL Moseley 2009
Why train the brain?
Recent developments
Go to the next Disrupted bodily
awareness
set of slides on
Disruption of
Recent high-order
cognitive
Developments representations.