Mental Representation Techniques for the Treatment of Parkinson´s Disease-related Pain
Mental Representation Techniques Targeting Pain in Parkinson´s Disease Patients: A Randomized Controlled Trial
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Anticipated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Madrid, Spain, 28007
- Hospital Beata María Ana
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Contact:
- Juan Pablo Romero Muñoz, MD. PhD.
- Phone Number: 1688 +34917091400
- Email: p.romero.prof@ufv.es
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Sub-Investigator:
- Yeray Gonzalez Zamorano, PT Msc.
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Neuroimaging study without previous pathologies.
- Score > 5 in transfers (bed to chair and back) item in Barthel Index.
- Score = or > 24 in Mini-Mental State Examination.
- Able to provide informed consent to participate in the study.
Exclusion Criteria:
- History of neurologic disease different from PD.
- Presence of non-related to PD pain.
- Dermatologic problems, wounds, or ulcers in the electrode's application area.
- Significative difficulties in language.
- History of alcohol or drugs abuse.
- Non-controlled medical problems.
- Pregnancy.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
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Experimental: Action Observation+Motor Imagery through BCI
Action Observation+Motor Imagery through a Brain-Computer Interface training paradigm in Virtual Reality using the "NeuRow" platform during 10 sessions of 20 minutes, divided in 4 series of 5 minutes.
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Patients will undergo the treatment through the NeuRow platform.
NeuRow is a gamified Brain-Computer Interface training paradigm in Virtual Reality (or neurogame) that allows patients to perform the same actions as they would do in real-life by imaging the movement.
In NeuRow, patients will see a boat and two high fidelity virtual arms gripping two oars in the first-person view.
Patients will have to imagine the movement of each corresponding hand to rotate each oar and progress, observing the movement imagined on screen.
The goal of the task is to collect as many flags as possible in a fixed amount of time.
In order to improve adherence, the number of flags collected will be recorded in each session.
It will be able to adapt the boat speed, turn speed, and cut-off angle, to help patients not to deviate in excess from the target.
The treatment itself will be performed for 20 minutes each session, divided into 4 series of 5 minutes to prevent fatigue.
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Placebo Comparator: Action Observation through non-related with movement illustrations
Control Action Observation protocol of non-related with movement illustrations during 10 sessions of 20 minutes, divided in 4 series of 5 minutes.
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The same configuration will be applied to simulate a BCI task, but playing a video about graphic illustrations, people's faces, and landscapes, never related to human movement.
They will address interesting and changing topics to avoid patient's boredom.
The control session will last 20 minutes, also divided into 4 series of 5 minutes and the therapist will give the instructions of observing and relax.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Change in King´s Parkinson´s Disease Pain Scale score
Time Frame: From Baseline at 2 weeks
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Parkinson´s Disease specific scale that evaluates the localization, frequency, and intensity of pain.
It has 14 items distributed in 7 domains: 1. Musculoskeletal Pain; 2. Chronic Pain; 3. Fluctuation-related Pain; 4. Nocturnal Pain; 5. Oro-facial Pain; 6. Discoloration, Oedema/Swelling Pain; 7. Radicular Pain.
Each item is scored by severity (0, none to 3, very severe) multiplied by frequency (0, never to 4, all the time) resulting in a subscore of 0 to 12, the sum of which gives the total score with a theoretical range from 0 to 168, with higher scores indicating more severity and frequency of pain.
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From Baseline at 2 weeks
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Change in King´s Parkinson´s Disease Pain Scale score
Time Frame: From Baseline at 1 month
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Parkinson´s Disease specific scale that evaluates the localization, frequency, and intensity of pain.
It has 14 items distributed in 7 domains: 1. Musculoskeletal Pain; 2. Chronic Pain; 3. Fluctuation-related Pain; 4. Nocturnal Pain; 5. Oro-facial Pain; 6. Discoloration, Oedema/Swelling Pain; 7. Radicular Pain.
Each item is scored by severity (0, none to 3, very severe) multiplied by frequency (0, never to 4, all the time) resulting in a subscore of 0 to 12, the sum of which gives the total score with a theoretical range from 0 to 168, with higher scores indicating more severity and frequency of pain.
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From Baseline at 1 month
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Change in Brief Pain Inventory score
Time Frame: From Baseline at 2 weeks
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It contains 15 items, including 2 multi-item scales to measure the intensity of pain and its impact on the function and welfare of patients.
It also presents open questions to assess the localization of pain and the treatment used for its management, just as its effectiveness.
Scores oscillate from 0 to 110, with higher scores indicating more pain and more impact on function and welfare of patients.
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From Baseline at 2 weeks
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Change in Brief Pain Inventory score
Time Frame: From Baseline at 1 month
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It contains 15 items, including 2 multi-item scales to measure the intensity of pain and its impact on the function and welfare of patients.
It also presents open questions to assess the localization of pain and the treatment used for its management, just as its effectiveness.
Scores oscillate from 0 to 110, with higher scores indicating more pain and more impact on function and welfare of patients.
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From Baseline at 1 month
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Change in Conditioned Pain Modulation
Time Frame: From Baseline at 2 weeks
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Assesses the descending pain modulatory system.
The Pain Pressure Threshold will be assessed in the middle of the distal phalanx of the thumb with ta handheld algometer, corresponding to the first test stimulus.
Afterward, the patient will immerse the contrary hand up to the wrist into stirred ice-cold water (0-4º) maintaining it for 3 minutes, corresponding to the conditioning stimulus.
If the pain is unbearable before the 3 minutes, the patient will be able to remove his/her hand.
Immediately after removing the hand, a second Pain Pressure Threshold measure will be performed in the same place as the first one, corresponding to the second test stimulus.
After 1-minute rest, a third Pain Pressure Threshold will be measured to assess the Conditioned Pain Modulation residual functioning.
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From Baseline at 2 weeks
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Change in Conditioned Pain Modulation
Time Frame: From Baseline at 1 month
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Assesses the descending pain modulatory system.
The Pain Pressure Threshold will be assessed in the middle of the distal phalanx of the thumb with ta handheld algometer, corresponding to the first test stimulus.
Afterward, the patient will immerse the contrary hand up to the wrist into stirred ice-cold water (0-4º) maintaining it for 3 minutes, corresponding to the conditioning stimulus.
If the pain is unbearable before the 3 minutes, the patient will be able to remove his/her hand.
Immediately after removing the hand, a second Pain Pressure Threshold measure will be performed in the same place as the first one, corresponding to the second test stimulus.
After 1-minute rest, a third Pain Pressure Threshold will be measured to assess the Conditioned Pain Modulation residual functioning.
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From Baseline at 1 month
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Change in Temporal Summation
Time Frame: From Baseline at 2 weeks
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Represents excitatory modulation processes.
It will be generated through the application of 10 pulses of the handheld pressure algometer over the middle of the distal phalanx of the thumb with the intensity of the Pain Pressure Threshold, previously calculated.
In each pulse, pressure intensity will be increasing at a rate of 2 kg/s over the previously determined Pain Pressure Threshold intensity, leaving an interstimulus interval of one second according to the optimal method reported for inducing Temporal Summation with pressure pain.
Before the first pressure pulse, subjects were taught to use a verbal numeric pain rating scale to rate the pain intensity of the first, fifth, and 10th pressure pulses.
The verbal numeric pain rating scale ranged from 0 ("no pain") to 10 ("the worst possible pain").
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From Baseline at 2 weeks
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Change in Temporal Summation
Time Frame: From Baseline at 1 month
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Represents excitatory modulation processes.
It will be generated through the application of 10 pulses of the handheld pressure algometer over the middle of the distal phalanx of the thumb with the intensity of the Pain Pressure Threshold, previously calculated.
In each pulse, pressure intensity will be increasing at a rate of 2 kg/s over the previously determined Pain Pressure Threshold intensity, leaving an interstimulus interval of one second according to the optimal method reported for inducing Temporal Summation with pressure pain.
Before the first pressure pulse, subjects were taught to use a verbal numeric pain rating scale to rate the pain intensity of the first, fifth, and 10th pressure pulses.
The verbal numeric pain rating scale ranged from 0 ("no pain") to 10 ("the worst possible pain").
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From Baseline at 1 month
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Changes in Pain Pressure Threshold
Time Frame: From Baseline at 2 weeks
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Two Pain Pressure Thresholds will be measured by a handheld algometer, one over the most painful area (peripheric hyperalgesia) and the other one over the middle of the distal phalanx of the thumb (central hyperalgesia).
The Pain Pressure Threshold will be applied with the algometer perpendicular to the skin increasing at a rate of 1 kg/s until the first sensation of pain. 3 measures with 30-seconds rest between them will be performed, taking the average as Pain Pressure Threshold.
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From Baseline at 2 weeks
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Changes in Pain Pressure Threshold
Time Frame: From Baseline at 1 month
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Two Pain Pressure Thresholds will be measured by a handheld algometer, one over the most painful area (peripheric hyperalgesia) and the other one over the middle of the distal phalanx of the thumb (central hyperalgesia).
The Pain Pressure Threshold will be applied with the algometer perpendicular to the skin increasing at a rate of 1 kg/s until the first sensation of pain. 3 measures with 30-seconds rest between them will be performed, taking the average as Pain Pressure Threshold.
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From Baseline at 1 month
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Beck Depression Inventory
Time Frame: Baseline
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Measures depressive symptoms.
Scores range from 0 to 63 leading to 6 groups: 0-10, normal; 11-16, mild mood disturbance; 17-20, borderline clinical depression; 21-30, moderate depression; 31-40, severe depression; and over 40, extreme depression.
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Baseline
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Beck Depression Inventory
Time Frame: At 2 weeks from Baseline
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Measures depressive symptoms.
Scores range from 0 to 63 leading to 6 groups: 0-10, normal; 11-16, mild mood disturbance; 17-20, borderline clinical depression; 21-30, moderate depression; 31-40, severe depression; and over 40, extreme depression.
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At 2 weeks from Baseline
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Beck Depression Inventory
Time Frame: At 1 month from Baseline
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Measures depressive symptoms.
Scores range from 0 to 63 leading to 6 groups: 0-10, normal; 11-16, mild mood disturbance; 17-20, borderline clinical depression; 21-30, moderate depression; 31-40, severe depression; and over 40, extreme depression.
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At 1 month from Baseline
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State-Trait Anxiety Inventory
Time Frame: Baseline
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Measures anxious states and anxious traits.
It has 20 items for assessing trait anxiety and 20 for state anxiety.
All items are rated on a 4-point scale (e.g., from "Almost Never" to "Almost Always").
Higher scores indicate greater anxiety.
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Baseline
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State-Trait Anxiety Inventory
Time Frame: At 2 weeks from Baseline
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Measures anxious states and anxious traits.
It has 20 items for assessing trait anxiety and 20 for state anxiety.
All items are rated on a 4-point scale (e.g., from "Almost Never" to "Almost Always").
Higher scores indicate greater anxiety.
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At 2 weeks from Baseline
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State-Trait Anxiety Inventory
Time Frame: At 1 month from Baseline
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Measures anxious states and anxious traits.
It has 20 items for assessing trait anxiety and 20 for state anxiety.
All items are rated on a 4-point scale (e.g., from "Almost Never" to "Almost Always").
Higher scores indicate greater anxiety.
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At 1 month from Baseline
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Tampa Scale of Kinesiophobia
Time Frame: Baseline
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Measures fear of movement-related pain.
Its scores range from 11-44 points with higher scores indicating greater fear of pain, movement, and injury.
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Baseline
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Tampa Scale of Kinesiophobia
Time Frame: At 2 weeks from Baseline
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Measures fear of movement-related pain.
Its scores range from 11-44 points with higher scores indicating greater fear of pain, movement, and injury.
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At 2 weeks from Baseline
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Tampa Scale of Kinesiophobia
Time Frame: At 1 month from Baseline
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Measures fear of movement-related pain.
Its scores range from 11-44 points with higher scores indicating greater fear of pain, movement, and injury.
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At 1 month from Baseline
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Pain Catastrophizing Scale
Time Frame: Baseline
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Measures catastrophizing thinking.
Its total score range from 0-52, along with three subscale scores assessing rumination, magnification and helplessness, with higher scores indicating higher level of catastrophizing.
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Baseline
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Pain Catastrophizing Scale
Time Frame: At 2 weeks from Baseline
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Measures catastrophizing thinking.
Its total score range from 0-52, along with three subscale scores assessing rumination, magnification and helplessness, with higher scores indicating higher level of catastrophizing.
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At 2 weeks from Baseline
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Pain Catastrophizing Scale
Time Frame: At 1 month from Baseline
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Measures catastrophizing thinking.
Its total score range from 0-52, along with three subscale scores assessing rumination, magnification and helplessness, with higher scores indicating higher level of catastrophizing.
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At 1 month from Baseline
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Unified Parkinson´s Disease Rating Scale
Time Frame: Baseline
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Measures disability in Parkinson´s Disease patients.
The scale itself has four components: Part I, Mentation, Behavior and Mood; Part II, Activities of Daily Living; Part III, Motor aspects; Part IV, Associated Complications.
Scores range from 0 to 159 with higher scores indicating more severity.
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Baseline
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Unified Parkinson´s Disease Rating Scale
Time Frame: At 2 weeks from Baseline
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Measures disability in Parkinson´s Disease patients.
The scale itself has four components: Part I, Mentation, Behavior and Mood; Part II, Activities of Daily Living; Part III, Motor aspects; Part IV, Associated Complications.
Scores range from 0 to 159 with higher scores indicating more severity.
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At 2 weeks from Baseline
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Unified Parkinson´s Disease Rating Scale
Time Frame: At 1 month from Baseline
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Measures disability in Parkinson´s Disease patients.
The scale itself has four components: Part I, Mentation, Behavior and Mood; Part II, Activities of Daily Living; Part III, Motor aspects; Part IV, Associated Complications.
Scores range from 0 to 159 with higher scores indicating more severity.
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At 1 month from Baseline
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Reaction Times
Time Frame: Baseline
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Performed through 2 related subtasks.
Finger Taping task, where the participants will be instructed to press the space bar on the keyboard as fast as possible and repeatedly with the index finger, to measure motor function.
And Simple Reaction Time task, where participants will be instructed to press the left mouse button as fast as possible when the stimulus "+" appears in the center of the screen at a size of 2 cm x 2 cm, to measure simple perception and sustained alertness.
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Baseline
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Reaction Times
Time Frame: At 2 weeks from Baseline
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Performed through 2 related subtasks.
Finger Taping task, where the participants will be instructed to press the space bar on the keyboard as fast as possible and repeatedly with the index finger, to measure motor function.
And Simple Reaction Time task, where participants will be instructed to press the left mouse button as fast as possible when the stimulus "+" appears in the center of the screen at a size of 2 cm x 2 cm, to measure simple perception and sustained alertness.
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At 2 weeks from Baseline
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Reaction Times
Time Frame: At 1 month from Baseline
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Performed through 2 related subtasks.
Finger Taping task, where the participants will be instructed to press the space bar on the keyboard as fast as possible and repeatedly with the index finger, to measure motor function.
And Simple Reaction Time task, where participants will be instructed to press the left mouse button as fast as possible when the stimulus "+" appears in the center of the screen at a size of 2 cm x 2 cm, to measure simple perception and sustained alertness.
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At 1 month from Baseline
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Transcranial Magnetic Stimulation
Time Frame: Baseline
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Action Motor Threshold in millivolts
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Baseline
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Transcranial Magnetic Stimulation
Time Frame: At 2 weeks from Baseline
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Action Motor Threshold in millivolts
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At 2 weeks from Baseline
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Transcranial Magnetic Stimulation
Time Frame: At 1 month from Baseline
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Action Motor Threshold in millivolts
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At 1 month from Baseline
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Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Josué Fernandez Carnero, PT PhD, Universidad Rey Juan Carlos
Publications and helpful links
General Publications
- Chaudhuri KR, Rizos A, Trenkwalder C, Rascol O, Pal S, Martino D, Carroll C, Paviour D, Falup-Pecurariu C, Kessel B, Silverdale M, Todorova A, Sauerbier A, Odin P, Antonini A, Martinez-Martin P; EUROPAR and the IPMDS Non Motor PD Study Group. King's Parkinson's disease pain scale, the first scale for pain in PD: An international validation. Mov Disord. 2015 Oct;30(12):1623-31. doi: 10.1002/mds.26270. Epub 2015 Jun 11.
- Kalia LV, Lang AE. Parkinson's disease. Lancet. 2015 Aug 29;386(9996):896-912. doi: 10.1016/S0140-6736(14)61393-3. Epub 2015 Apr 19.
- Martinez-Martin P, Rodriguez-Blazquez C, Kurtis MM, Chaudhuri KR; NMSS Validation Group. The impact of non-motor symptoms on health-related quality of life of patients with Parkinson's disease. Mov Disord. 2011 Feb 15;26(3):399-406. doi: 10.1002/mds.23462. Epub 2011 Jan 24.
- Antonini A, Tinazzi M, Abbruzzese G, Berardelli A, Chaudhuri KR, Defazio G, Ferreira J, Martinez-Martin P, Trenkwalder C, Rascol O. Pain in Parkinson's disease: facts and uncertainties. Eur J Neurol. 2018 Jul;25(7):917-e69. doi: 10.1111/ene.13624. Epub 2018 Apr 18.
- Wright DJ, Williams J, Holmes PS. Combined action observation and imagery facilitates corticospinal excitability. Front Hum Neurosci. 2014 Nov 27;8:951. doi: 10.3389/fnhum.2014.00951. eCollection 2014.
- Vourvopoulos A, Ferreira A, Bermúdez i Badia S. NeuRow: An Immersive VR Environment for Motor-Imagery Training with the Use of Brain-Computer Interfaces and Vibrotactile Feedback. 2016.
- Morales Tejera D, Fernandez-Carnero J, Suso-Marti L, Cano-de-la-Cuerda R, Lerin-Calvo A, Remon-Ramiro L, La Touche R. Comparative study of observed actions, motor imagery and control therapeutic exercise on the conditioned pain modulation in the cervical spine: a randomized controlled trial. Somatosens Mot Res. 2020 Sep;37(3):138-148. doi: 10.1080/08990220.2020.1756244. Epub 2020 Apr 27.
- Vourvopoulos A, Jorge C, Abreu R, Figueiredo P, Fernandes JC, Bermudez I Badia S. Efficacy and Brain Imaging Correlates of an Immersive Motor Imagery BCI-Driven VR System for Upper Limb Motor Rehabilitation: A Clinical Case Report. Front Hum Neurosci. 2019 Jul 11;13:244. doi: 10.3389/fnhum.2019.00244. eCollection 2019.
- Perez-Lloret S, Ciampi de Andrade D, Lyons KE, Rodriguez-Blazquez C, Chaudhuri KR, Deuschl G, Cruccu G, Sampaio C, Goetz CG, Schrag A, Martinez-Martin P, Stebbins G; Members of the MDS Committee on Rating Scales Development. Rating Scales for Pain in Parkinson's Disease: Critique and Recommendations. Mov Disord Clin Pract. 2016 Jun 24;3(6):527-537. doi: 10.1002/mdc3.12384. eCollection 2016 Nov-Dec.
- Imai Y, Petersen KK, Morch CD, Arendt Nielsen L. Comparing test-retest reliability and magnitude of conditioned pain modulation using different combinations of test and conditioning stimuli. Somatosens Mot Res. 2016 Sep-Dec;33(3-4):169-177. doi: 10.1080/08990220.2016.1229178. Epub 2016 Sep 20.
- Santos-Garcia D, Oreiro M, Perez P, Fanjul G, Paz Gonzalez JM, Feal Painceiras MJ, Cores Bartolome C, Valdes Aymerich L, Garcia Sancho C, Castellanos Rodrigo MDM. Impact of Coronavirus Disease 2019 Pandemic on Parkinson's Disease: A Cross-Sectional Survey of 568 Spanish Patients. Mov Disord. 2020 Oct;35(10):1712-1716. doi: 10.1002/mds.28261. Epub 2020 Sep 22.
Study record dates
Study Major Dates
Study Start (Anticipated)
Study Start
Primary Completion (Anticipated)
Primary Completion
Study Completion (Anticipated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- PainPD-Imagine
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- Study Protocol
- Statistical Analysis Plan (SAP)
- Informed Consent Form (ICF)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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