Investigating patient outcomes following an intensive multidisciplinary rehabilitation programme, for the treatment of Complex Regional Pain Syndrome (CRPS) at a UK National specialist centre for pain
Year: 2018
Type: conference-paper
Abstract: AIM OF INVESTIGATION \nComplex Regional Pain Syndrome (CRPS) is a condition characterised by highly distressing, persistent pain, which is usually trauma-induced but the associated pain is out of proportion to the initiating event. A number of mechanisms are thought to be involved; these include peripheral inflammation, autonomic dysregulation and cortical reconfiguration. Yet the spectrum of signs and symptoms in which individuals present with the condition, can make both diagnosing and effectively treating CRPS, a challenge. Although approximately 85% of cases resolve within the first year, a small proportion of cases are considered treatment resistant to unimodal interventions commonly available through the UK National Health Service. As the condition can lead to profound physical disability and emotional suffering, it is necessary to investigate whether these individuals can be effectively treated using a comprehensive multidisciplinary rehabilitation programme. Similar pain management programmes have been shown to be effective in the treatment of various pain conditions, including chronic back, neck, pelvic pain, chronic headache, fibromyalgia, and chronic post-traumatic pain. However, there is very little published data concerning the effectiveness of multidisciplinary programs for treatment resistant CRPS. This study sought to address this literature gap. \n \nMETHODS \nPatients, who fulfilled the Budapest Criteria for CRPS and completed a two week inpatient rehabilitation programme, were asked to complete pre and post intervention measures. These measures indexed pain perception and pain interference (BPI), kinesiophobia (TAMPA), physical functioning and perceived disability (WAQ, Quick-DASH) and emotional wellbeing (PHQ-9 for depression, GAD-7 for anxiety). Data were captured between 2014 and 2017, as a routine clinical measure at a national specialist centre for pain. \n \nThe specialist CRPS rehabilitation programme incorporates physical and occupational therapy, hydrotherapy, pain psychology, patient education on the condition, seminars on pacing, medication, sleep-hygiene and relaxation training. \n \nThe present sample was comprised of 223 participants, aged 18-78 (M= 46.1yrs, SD 12.76; 70.9% female, 29.1% male). Over half (53.2%) had been living with symptoms of pain for over 2 years, 38% reported that they were initially affected with upper limb CRPS and 62% lower limb CRPS. Within this sample 54% were unemployed at the time of admission, with a mean unemployed duration of 23.2months, (SD= 17.77). The data set was examined using both inferential and descriptive statistics (t-test and percentage change scores respectively). \n \nRESULTS \nFindings demonstrated significant reductions (p<0.001) in pain perception (pre-intervention M=6.7, SD=1.7, post-intervention M= 6.2, SD=2.0), pain interference (pre-intervention M=6.9, SD=2.0, post-intervention M=5.8, SD= 2.3), pain self-efficacy (pre-intervention M= 19.9, SD= 11.8, post-intervention M=26.8, SD= 12.3) and kinesiophobia (pre intervention M=28.0, SD=6.4, post-intervention M=24.3, SD=5.9). Patients also reported improvements (p<0.001) in measures of depression (pre-intervention, M=14.8, SD=6.9, post-intervention, M=11.3, SD=6.1) and anxiety (pre-intervention, M=11.4, SD=6.0, post-intervention, M=8.8, SD=5.5). There were also significant improvements in physical functioning and perceived disability as indexed on the Quick-Dash for upper limb CRPS patients (pre-intervention, M=69.2, SD=18.8, post intervention M=62.5, SD=17.8, p<0.001) but non-significant improvements on the WAQ for lower limb CRPS patients (pre-intervention, M=23.8, SD=10.9, post-intervention M=22.9 SD=11.5, p=.07). Of all these results the greatest improvements were shown in pain self-efficacy (percentage change, 84.2%), rather than pain perception (percentage change, 5.4%). \n \nCONCLUSIONS \nThis study indicates that intensive rehabilitation programmes can yield significant improvements across a number of measures indexing physical and emotional functioning, for long term, complex, treatment resistant CRPS. This challenges a widely held belief that treatment gains are usually restricted to the first year post trauma. These findings are in line with the premise that improving general functioning and self-efficacy should be the primary treatment goal for individuals diagnosed with longer term CRPS, rather than a sole focus of pain reduction. Future data analysis is scheduled to determine if these gains are sustained in the longer term.
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2805708835