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Pain reduction due to novel sensory-motor training in Complex Regional Pain Syndrome I – A pilot study

  • Anne-Christine Schmid EMAIL logo , Anja Schwarz , Sylvia M. Gustin , Joel D. Greenspan , Friedhelm C. Hummel and Niels Birbaumer


Background and aims

Patients suffering from Complex Regional Pain Syndrome (CRPS) of the upper limb show a changed cortical representation of the affected hand. The lip area invades the former hand area contralateral to the affected hand. This change in cortical representation is correlated to the intensity of ongoing pain in patients with CRPS. Further studies revealed that restoration of the original representation coincides with a decrease of pain. Sensory-motor training protocols can increase and/or relocate cortical somatosensory and motor representation areas of the fingers, as shown, for example, in Braille reading individuals and professional violin players. Further, there is evidence that sensory-motor discrimination training has a beneficial effect on both the intensity of pain and the mislocalization of sensory-motor cortical areas in CRPS patients. Based on these propositions, we developed a novel sensory-motor self-training paradigm for CRPS patients to use in a home-based manner.


Ten CRPS patients performed the sensory-motor training for 2 weeks. The training consists of a braille-like haptic task with different training modes (bi-manual, speed and memory training). During the training, as well as 1 week before and after, patients were asked to fill out pain diaries. Furthermore, measures of impairment were acquired at baseline and post training.


Patients showed significant pain reduction after the 2 week training period. The overall disability as well as the depression scores showed a trend to improve after the 2 week training. The reduction in pain was correlated with the total amount of training performed.


This is a first proof of principle study of a novel sensory-motor self-training protocol to reduce pain in CRPS patients. The more consistent the patients trained the larger the pain reduction. Sensory-motor training, which can be performed on a regular basis at home might provide a novel interventional strategy to improve symptoms of CRPS.


Although a larger study needs to be conducted to confirm our findings, including long-term follow-up, the results show, that a sensory-motor home-based training is a strategy worth exploring further for the reduction of pain as well as high frequency training for patients with CRPS.

DOI of refers to article:

EPFL SV BMI UPHUMMEL Clinique Romande de Réadaptation (CRR) E1 B2 Campus SUVA Av. Grand-Champsec 90 CP 352 1951 Sion, Switzerland;Brain Mind Institute, SV Centre of Neuroprosthetics (CNP), Swiss Federal Institute of Technology (EPFL), Campus Biotech 9, Chemin des Mines 1202 Geneva, Swizerland.Tel.: +49 40 7410 55573; fax: +49 40 7410 57391.

  1. Author contributions: All authors discussed the results and commented on themanuscript.

  2. Ethical issues: Written informed consent was obtained from all subjects according to the Declaration of Helsinki ( and withapproval from the local Ethics Committee of the Medical Faculty of the University of Tuebingen.

  3. Funding: This study was supported by Bundesministerium für Bildung und Forschung (BMBF grant D 20.01667) and Deutsche Forschungsgesellschaft (DFG grant BI195/63–1).

  4. Conflict of interest: The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.


Abd Al-Jabbar Al-Shukry, Merlin Evers, Hendrik Heinzl, Harrison Norman, Daniela Palme, Myriam Wurst helped with the data acquisition.


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Center for Epidemiological Studies – Depression Scale


Complex Regional Pain Syndrome


Primary motor cortex


Pain DisabilityIndex


Physical Therapy


Primary sensory cortex


Sensory-motor Training


Transcranial Direct Current Stimulation


Transcranial Magnetic Stimulation


Visual Analogue Scale.

Appendix A. Supplementary data

Supplementary data associated with this article can be found, in the online version, at http://dx.doi.Org/10.1016/j.sjpain.2016.11.003.

Received: 2016-07-04
Revised: 2016-11-03
Accepted: 2016-11-09
Published Online: 2017-04-01
Published in Print: 2017-04-01

© 2016 Scandinavian Association for the Study of Pain

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