Mental Representation Techniques for the Treatment of Parkinson´s Disease-related Pain
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ClinicalTrials.gov Identifier: NCT04651478 |
Recruitment Status :
Not yet recruiting
First Posted : December 3, 2020
Last Update Posted : December 23, 2020
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Condition or disease | Intervention/treatment | Phase |
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Parkinson Disease Pain | Behavioral: Action Observation+Motor Imagery through BCI Behavioral: Action Observation through non-related with movement illustrations | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 32 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Intervention Model Description: | This study will be a double-blinded experimental longitudinal prospective randomized controlled trial with a parallel design. The randomization will be realized through randomization software. All the participants who fulfill the inclusion criteria and have none of the exclusion ones will be randomly allocated into two groups: AO+MI through a Brain-Computer Interface (BCI) training paradigm in Virtual Reality (VR) (AO+MI-BCI) or AO of non-related with movement illustrations (AO-control). Allocation concealment will be ensured by the inclusion of the assigned group in closed opaque envelopes that will be opened at the time of the intervention. |
Masking: | Triple (Participant, Investigator, Outcomes Assessor) |
Masking Description: | Double-blind criteria will be achieved by following the same protocol with the same instruments in both groups. The evaluator will not be able to stay in the same room during the intervention and patients will not know the instructions and specific hypotheses of each protocol. The statistician will be blinded through the assignment of neutral numbers to both groups. Patients recruited will not meet in waiting rooms to avoid them to comment on their experience during the protocol. Unblinding will be permissible when any event could suppose a risk for the patient's health. |
Primary Purpose: | Treatment |
Official Title: | Mental Representation Techniques Targeting Pain in Parkinson´s Disease Patients: A Randomized Controlled Trial |
Estimated Study Start Date : | January 2021 |
Estimated Primary Completion Date : | October 2021 |
Estimated Study Completion Date : | December 2021 |

Arm | Intervention/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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Behavioral: Action Observation+Motor Imagery through BCI
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. |
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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Behavioral: Action Observation through non-related with movement illustrations
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. |
- Change in King´s Parkinson´s Disease Pain Scale score [ Time Frame: From Baseline at 2 weeks ]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.
- Change in King´s Parkinson´s Disease Pain Scale score [ Time Frame: From Baseline at 1 month ]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.
- Change in Brief Pain Inventory score [ Time Frame: From Baseline at 2 weeks ]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.
- Change in Brief Pain Inventory score [ Time Frame: From Baseline at 1 month ]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.
- Change in Conditioned Pain Modulation [ Time Frame: From Baseline at 2 weeks ]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.
- Change in Conditioned Pain Modulation [ Time Frame: From Baseline at 1 month ]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.
- Change in Temporal Summation [ Time Frame: From Baseline at 2 weeks ]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").
- Change in Temporal Summation [ Time Frame: From Baseline at 1 month ]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").
- Changes in Pain Pressure Threshold [ Time Frame: From Baseline at 2 weeks ]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.
- Changes in Pain Pressure Threshold [ Time Frame: From Baseline at 1 month ]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.
- Beck Depression Inventory [ Time Frame: Baseline ]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.
- Beck Depression Inventory [ Time Frame: At 2 weeks from Baseline ]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.
- Beck Depression Inventory [ Time Frame: At 1 month from Baseline ]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.
- State-Trait Anxiety Inventory [ Time Frame: Baseline ]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.
- State-Trait Anxiety Inventory [ Time Frame: At 2 weeks from Baseline ]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.
- State-Trait Anxiety Inventory [ Time Frame: At 1 month from Baseline ]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.
- Tampa Scale of Kinesiophobia [ Time Frame: Baseline ]Measures fear of movement-related pain. Its scores range from 11-44 points with higher scores indicating greater fear of pain, movement, and injury.
- Tampa Scale of Kinesiophobia [ Time Frame: At 2 weeks from Baseline ]Measures fear of movement-related pain. Its scores range from 11-44 points with higher scores indicating greater fear of pain, movement, and injury.
- Tampa Scale of Kinesiophobia [ Time Frame: At 1 month from Baseline ]Measures fear of movement-related pain. Its scores range from 11-44 points with higher scores indicating greater fear of pain, movement, and injury.
- Pain Catastrophizing Scale [ Time Frame: Baseline ]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.
- Pain Catastrophizing Scale [ Time Frame: At 2 weeks from Baseline ]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.
- Pain Catastrophizing Scale [ Time Frame: At 1 month from Baseline ]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.
- Unified Parkinson´s Disease Rating Scale [ Time Frame: Baseline ]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.
- Unified Parkinson´s Disease Rating Scale [ Time Frame: At 2 weeks from Baseline ]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.
- Unified Parkinson´s Disease Rating Scale [ Time Frame: At 1 month from Baseline ]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.
- Reaction Times [ Time Frame: Baseline ]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.
- Reaction Times [ Time Frame: At 2 weeks from Baseline ]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.
- Reaction Times [ Time Frame: At 1 month from Baseline ]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.
- Transcranial Magnetic Stimulation [ Time Frame: Baseline ]Action Motor Threshold in millivolts
- Transcranial Magnetic Stimulation [ Time Frame: At 2 weeks from Baseline ]Action Motor Threshold in millivolts
- Transcranial Magnetic Stimulation [ Time Frame: At 1 month from Baseline ]Action Motor Threshold in millivolts

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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
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.

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04651478
Contact: Juan Pablo Romero Muñoz, MD PhD | +34917091400 ext 1688 | p.romero.prof@ufv.es |
Spain | |
Hospital Beata María Ana | |
Madrid, Spain, 28007 | |
Contact: Juan Pablo Romero Muñoz, MD. PhD. +34917091400 ext 1688 p.romero.prof@ufv.es | |
Sub-Investigator: Yeray Gonzalez Zamorano, PT Msc. |
Principal Investigator: | Juan Pablo Romero Muñoz, MD PhD | Universidad Francisco de Vitoria, Facultad de Ciencias Experimentales | |
Principal Investigator: | Josue Fernández Carnero, PT PhD | Universidad Rey Juan Carlos |
Responsible Party: | Universidad Francisco de Vitoria |
ClinicalTrials.gov Identifier: | NCT04651478 |
Other Study ID Numbers: |
PainPD-Imagine |
First Posted: | December 3, 2020 Key Record Dates |
Last Update Posted: | December 23, 2020 |
Last Verified: | November 2020 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | Yes |
Plan Description: | Individual anonymized participant data will be available to other researchers under request. |
Supporting Materials: |
Study Protocol Statistical Analysis Plan (SAP) Informed Consent Form (ICF) |
Time Frame: | Six months at the end of the study. |
Access Criteria: | Individual anonymized participant data will be available to other researchers under request. |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Parkinson Disease Pain Action Observation Motor Imagery Virtual Reality |
Parkinson Disease Parkinsonian Disorders Basal Ganglia Diseases Brain Diseases |
Central Nervous System Diseases Nervous System Diseases Movement Disorders Neurodegenerative Diseases |