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Beales D, Ho YK, Lewin J, Loh BWQ, Yusof AB, Grieve S, Ranelli S, Holthouse D, Mitchell T, Slater H. Participatory design of an infographic to help support the care of people living with complex regional pain syndrome. Br J Pain 2023; 17:519-531. [PMID: 37969133 PMCID: PMC10642498 DOI: 10.1177/20494637231190587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Complex regional pain syndrome (CRPS) can be a debilitating pain condition with enduring physical, psychological and social impacts. CRPS is often poorly understood by healthcare professionals and management needs to be tailored to each individual's presentation. People with lived experience express difficulty in accessing reliable and meaningful information about the condition. This study aimed to co-create a trustworthy infographic to share information about the lived experience of CRPS. Methods We adopted a seven-phase, iterative, participatory methodology to co-create the infographic. Potential infographic content was obtained from qualitative work investigating the lived experience of CRPS. Online consumer engagement (people with doctor diagnosed CRPS/their family, n=20) was used to prioritise content to be included in the infographic and then potential designs were sourced. The research team narrowed the selections down to two designs which were presented to consumers online for final selection (n=25) and refinement (n=34). Results An infographic for understanding the lived experience of CRPS was completed using participatory design, providing a resource aligned to the needs of people with this condition. Using the Patient Education Materials Assessment Tool, the final infographic rated highly for understandability (92%) and participants indicated significant willingness to share this infographic with others (93%). Conclusion A process of participatory design was an effective and efficient process for translation of evidence gathered from qualitative research into a trustworthy resource for people with CRPS and their support people.
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Affiliation(s)
- Darren Beales
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Yi Ki Ho
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - James Lewin
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Bianca Wen-Qi Loh
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Amirah Binte Yusof
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Sharon Grieve
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- University of the West of England, Bristol, UK
| | - Sonia Ranelli
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | | | | | - Helen Slater
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA, Australia
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Griffiths GS, Thompson BL, Snell DL, Dunn JA. Experiences of diagnosis and treatment for upper limb Complex Regional Pain Syndrome: a qualitative analysis. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1355-1363. [PMID: 37584744 PMCID: PMC10690851 DOI: 10.1093/pm/pnad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/21/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Complex Regional Pain Syndrome (CRPS) most frequently affects the upper limb, with high associated disability. Delays to diagnosis and appropriate treatment can adversely impact prognosis and quality of life, but little is known about the healthcare experiences of people with CRPS. This study aimed to explore lived experiences of diagnosis and treatment for people with upper limb CRPS. METHODS Participants were recruited through online support groups and multiple public and private healthcare settings in the Greater Wellington Region, New Zealand. Semi-structured interviews were conducted with participants who had experienced upper limb CRPS for more than three months and less than three years. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. RESULTS Thirteen participants (11 female, 2 male) aged between 43 and 68 years were interviewed. Duration of CRPS ranged from 7 months to 2.5 years. Five themes were identified. Participants initially engaged in healthcare out of a desire to return to being the person they were before having CRPS. Three interacting experiences epitomised the overall healthcare experience: (1) not knowing what is going on, (2) not being taken seriously, and (3) healthcare as adding another layer of load. Meanwhile, participants used multiple approaches in an attempt to not let CRPS stop them from continuing to live their lives. CONCLUSIONS Participants in this study felt that credible information, validation, and simplification from healthcare providers and systems would support their process of navigating towards a meaningful life and self-concept in the presence of CRPS.
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Affiliation(s)
- Grace S Griffiths
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch 8011, New Zealand
| | - Bronwyn L Thompson
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch 8011, New Zealand
| | - Deborah L Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch 8011, New Zealand
| | - Jennifer A Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch 8011, New Zealand
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Vidal-Jiménez E, Carvajal-Parodi C, Guede-Rojas F. Complex regional pain syndrome type II localized to the index finger. A case report translating scientific evidence into clinical practice. Physiother Theory Pract 2023:1-14. [PMID: 37909770 DOI: 10.1080/09593985.2023.2276379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Complex regional pain syndrome type II (CRPS-II) is a rare condition associated with peripheral nervous system lesions. Its localized distribution in the fingers is unique, and its treatment is unclear. CASE DESCRIPTION A 56-year-old male presented to the emergency department with a saw-cut index finger injury with associated tendon and nerve injuries. After surgery, he was admitted to physical therapy (PT) with persistent pain, joint stiffness, allodynia, and trophic changes compatible with CRPS-II localized in the index finger. The diagnosis was confirmed after applying the Budapest Criteria, and PT was progressive and individualized according to the patient's needs, including graded motor imagery, mobilizations, exercises, and education. OUTCOMES After 12 weeks of PT, a clinically significant decrease in pain intensity and improvements in mobility and index finger and upper limb functionality was observed, reducing CRPS symptomatology. DISCUSSION This report provides information about a unique case of a localized form of CRPS-II. After reviewing the literature on clinical cases of both CRPS-II and localized forms of CRPS, we highlight that the clinical features of this patient and his positive therapeutic response support the importance of translating the scientific evidence on CRPS into clinical practice.
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Affiliation(s)
- Esteban Vidal-Jiménez
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Herminda Martín, Chillán, Ñuble, Chile
| | - Claudio Carvajal-Parodi
- Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián Concepción, Bíobío, Chile
| | - Francisco Guede-Rojas
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
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Wu L, Liu M, Huang C, Yin J, Zhou H, Hu H. The development of a self-management evaluation scale for elderly adults with hypertension based on the capability, opportunity, and motivation-behaviour (COM-B) model. BMC Geriatr 2023; 23:245. [PMID: 37087433 PMCID: PMC10122353 DOI: 10.1186/s12877-023-03879-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/08/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Using accurate assessment tools to assess patients in clinical practice is important to mining influencing factors and implementing interventions. However, most evaluation tools for the self-management of elderly patients with hypertension lack a theoretical basis and wide applicability, which makes the intervention effect insignificant. METHODS Based on the Capability, Opportunity, and Motivation-Behaviour (COM-B) model, combined with literature review and qualitative research, a questionnaire item pool was initially formulated; then the initial items were screened and adjusted through expert consultation and pre-testing to form an initial scale. A field survey of 450 elderly hypertensive patients was then performed using the initial scale to test the reliability and validity of the scale. Cronbach's alpha, test-retest reliability and composite reliability were used to test the reliability of the scale, and the validity of the scale was evaluated from two aspects: content validity and construct validity. The evaluation results of the content validity of the scale by experts were used as the content validity index; the results of exploratory factor analysis and confirmatory factor analysis were used as the structural validity index to further verify the model structure of the scale and develop a formal scale. RESULTS The final self-management scale included 4 dimensions and 33 items. The Scale-Content Validity Index was 0.920. Exploratory factor analysis extracted four factors that explained 71.3% of the total variance. Cronbach's alpha of the formal scale was 0.867, test-retest reliability was 0.894, and composite reliability of the 4 dimensions were within 0.943 ~ 0.973. Confirmatory factor analysis showed the scale had good construct validity. CONCLUSIONS The Self-management Capability, Support and Motivation-Behaviour scale for elderly hypertensive patients has good reliability and validity, providing a tool for medical staff to evaluate the self-management level of elderly hypertensive patients.
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Affiliation(s)
- Lirong Wu
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, 410013, Changsha, China
| | - Minhui Liu
- Nursing School of Central South University, Changsha, 410013, China
| | - Chongmei Huang
- Nursing School of Central South University, Changsha, 410013, China
| | - Jinzhi Yin
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, 410013, Changsha, China
| | - Hui Zhou
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, 410013, Changsha, China
| | - Hongjuan Hu
- The First Affiliated Hospital, Department of Public Service/Nursing department, Hengyang Medical School, University of South China, Hunan, 421001, Hengyang, China.
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Harden RN, McCabe CS, Goebel A, Massey M, Suvar T, Grieve S, Bruehl S. Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 5th Edition. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:S1-S53. [PMID: 35687369 PMCID: PMC9186375 DOI: 10.1093/pm/pnac046] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/23/2022]
Abstract
There have been some modest recent advancements in the research of Complex Regional Pain Syndrome, yet the amount and quality of the work in this complicated multifactorial disease remains low (with some notable exceptions; e.g., the recent work on the dorsal root ganglion stimulation). The semi-systematic (though in some cases narrative) approach to review is necessary so that we might treat our patients while waiting for "better research." This semi-systematic review was conducted by experts in the field, (deliberately) some of whom are promising young researchers supplemented by the experience of "elder statesman" researchers, who all mention the system they have used to examine the literature. What we found is generally low- to medium-quality research with small numbers of subjects; however, there are some recent exceptions to this. The primary reason for this paucity of research is the fact that this is a rare disease, and it is very difficult to acquire a sufficient sample size for statistical significance using traditional statistical approaches. Several larger trials have failed, probably due to using the broad general diagnostic criteria (the "Budapest" criteria) in a multifactorial/multi-mechanism disease. Responsive subsets can often be identified in these larger trials, but not sufficient to achieve statistically significant results in the general diagnostic grouping. This being the case the authors have necessarily included data from less compelling protocols, including trials such as case series and even in some instances case reports/empirical information. In the humanitarian spirit of treating our often desperate patients with this rare syndrome, without great evidence, we must take what data we can find (as in this work) and tailor a treatment regime for each patient.
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Affiliation(s)
- R Norman Harden
- Departments of PM&R and Physical Therapy and Human Movement Sciences, Northwestern University
| | - Candida S McCabe
- University of the West of England, Stapleton, Bristol, UK
- Dorothy House Hospice, Bradford-on-Avon, Wilts, UK
| | - Andreas Goebel
- Pain Research Institute, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Michael Massey
- CentraCare Neurosciences Pain Center, CentraCare, St. Cloud, Minnesota, USA
| | - Tolga Suvar
- Department of Anesthesiology and Pain Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Sharon Grieve
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Centers, Nashville, Tennessee, USA
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Moore E, Braithwaite FA, Stanton TR, Bellan V, Moseley GL, Berryman C. What do I need to know? Essential educational concepts for complex regional pain syndrome. Eur J Pain 2022; 26:1481-1498. [PMID: 35598314 PMCID: PMC9542775 DOI: 10.1002/ejp.1976] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/01/2022] [Accepted: 05/07/2022] [Indexed: 11/12/2022]
Abstract
Background Methods Results Conclusion Significance
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Affiliation(s)
- E. Moore
- IIMPACT in Health The University of South Australia Kaurna Country Adelaide Australia
| | - F. A. Braithwaite
- IIMPACT in Health The University of South Australia Kaurna Country Adelaide Australia
| | - T. R. Stanton
- IIMPACT in Health The University of South Australia Kaurna Country Adelaide Australia
| | - V. Bellan
- IIMPACT in Health The University of South Australia Kaurna Country Adelaide Australia
| | - G. L. Moseley
- IIMPACT in Health The University of South Australia Kaurna Country Adelaide Australia
- Neuroscience Research Australia, Randwick Sydney Australia
| | - C. Berryman
- IIMPACT in Health The University of South Australia Kaurna Country Adelaide Australia
- Brain Stimulation, Imaging and Cognition Group School of Medicine The University of Adelaide, Kaurna Country Adelaide Australia
- Corresponding author. Carolyn Berryman, Level 7 Centenary Building University of South Australia Kaurna Country, Adelaide, Australia, 5005
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Smart KM, Ferraro MC, Wand BM, O'Connell NE. Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II. Cochrane Database Syst Rev 2022; 5:CD010853. [PMID: 35579382 PMCID: PMC9112661 DOI: 10.1002/14651858.cd010853.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is a painful and disabling condition that usually manifests in response to trauma or surgery and is associated with significant pain and disability. CRPS can be classified into two types: type I (CRPS I) in which a specific nerve lesion has not been identified and type II (CRPS II) where there is an identifiable nerve lesion. Guidelines recommend the inclusion of a variety of physiotherapy interventions as part of the multimodal treatment of people with CRPS. This is the first update of the review originally published in Issue 2, 2016. OBJECTIVES To determine the effectiveness of physiotherapy interventions for treating pain and disability associated with CRPS types I and II in adults. SEARCH METHODS For this update we searched CENTRAL (the Cochrane Library), MEDLINE, Embase, CINAHL, PsycINFO, LILACS, PEDro, Web of Science, DARE and Health Technology Assessments from February 2015 to July 2021 without language restrictions, we searched the reference lists of included studies and we contacted an expert in the field. We also searched additional online sources for unpublished trials and trials in progress. SELECTION CRITERIA We included randomised controlled trials (RCTs) of physiotherapy interventions compared with placebo, no treatment, another intervention or usual care, or other physiotherapy interventions in adults with CRPS I and II. Primary outcomes were pain intensity and disability. Secondary outcomes were composite scores for CRPS symptoms, health-related quality of life (HRQoL), patient global impression of change (PGIC) scales and adverse effects. DATA COLLECTION AND ANALYSIS Two review authors independently screened database searches for eligibility, extracted data, evaluated risk of bias and assessed the certainty of evidence using the GRADE system. MAIN RESULTS We included 16 new trials (600 participants) along with the 18 trials from the original review totalling 34 RCTs (1339 participants). Thirty-three trials included participants with CRPS I and one trial included participants with CRPS II. Included trials compared a diverse range of interventions including physical rehabilitation, electrotherapy modalities, cortically directed rehabilitation, electroacupuncture and exposure-based approaches. Most interventions were tested in small, single trials. Most were at high risk of bias overall (27 trials) and the remainder were at 'unclear' risk of bias (seven trials). For all comparisons and outcomes where we found evidence, we graded the certainty of the evidence as very low, downgraded due to serious study limitations, imprecision and inconsistency. Included trials rarely reported adverse effects. Physiotherapy compared with minimal care for adults with CRPS I One trial (135 participants) of multimodal physiotherapy, for which pain data were unavailable, found no between-group differences in pain intensity at 12-month follow-up. Multimodal physiotherapy demonstrated a small between-group improvement in disability at 12 months follow-up compared to an attention control (Impairment Level Sum score, 5 to 50 scale; mean difference (MD) -3.7, 95% confidence interval (CI) -7.13 to -0.27) (very low-certainty evidence). Equivalent data for pain were not available. Details regarding adverse events were not reported. Physiotherapy compared with minimal care for adults with CRPS II We did not find any trials of physiotherapy compared with minimal care for adults with CRPS II. AUTHORS' CONCLUSIONS The evidence is very uncertain about the effects of physiotherapy interventions on pain and disability in CRPS. This conclusion is similar to our 2016 review. Large-scale, high-quality RCTs with longer-term follow-up are required to test the effectiveness of physiotherapy-based interventions for treating pain and disability in adults with CRPS I and II.
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Affiliation(s)
- Keith M Smart
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Physiotherapy Department, St Vincent's University Hospital, Dublin, Ireland
| | - Michael C Ferraro
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
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Antunovich D, Tuck N, Reynolds LM, Bean D. "I Don't Identify with It": A Qualitative Analysis of People's Experiences of Living with Complex Regional Pain Styndrome. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:3008-3020. [PMID: 33693870 DOI: 10.1093/pm/pnab094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 02/14/2021] [Accepted: 03/04/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Complex regional pain syndrome (CRPS) is a painful limb condition known to cause significant disability and distress. However, little previous research has explored CRPS from a patient perspective. The present qualitative study aimed to describe the experiences of people living with CRPS. SUBJECTS Forty-eight people with CRPS participated in this research. METHODS Participants completed a face-to-face or telephone interview about their perceptions and experiences of CRPS and completed three drawings to illustrate their experiences. Data were analyzed through reflexive thematic analysis, and images in drawings were grouped and coded by theme. RESULTS Three overarching themes encapsulated the data, including that 1) people experience CRPS as a source of severe symptoms and emotional difficulties, 2) CRPS undermines personal and social identity, and 3) this results in psychological responses that protect against the emotional and social impact of severe symptoms. Psychological responses include: a) searching for an explanation, b) "nothing is my fault," emphasizing a lack of personal responsibility and personal control, and c) detaching the limb from the self. CONCLUSIONS CRPS is experienced as highly threatening to physical ability, psychological state, and identity. In response to these threats, people may develop their own explanations for CRPS and may mentally detach themselves from responsibility, control, and the painful limb itself. Future research could explore the impact of these factors on psychological well-being and CRPS symptoms and outcomes.
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Affiliation(s)
- Dana Antunovich
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
- Pain Service, Northland District Health Board, Northland, New Zealand
| | - Natalie Tuck
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
- Chronic Pain Service, Department of Anaesthesia and Perioperative Medicine, Waitemata District Health Board, Auckland, New Zealand
| | - Lisa M Reynolds
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Debbie Bean
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Chronic Pain Service, Department of Anaesthesia and Perioperative Medicine, Waitemata District Health Board, Auckland, New Zealand
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Moore E, Stanton TR, Traeger A, Moseley GL, Berryman C. Determining the credibility, accuracy and comprehensiveness of websites educating consumers on complex regional pain syndrome accessible in Australia: a systematic review. Aust J Prim Health 2021; 27:485-495. [PMID: 34814978 DOI: 10.1071/py21066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/03/2021] [Indexed: 01/20/2023]
Abstract
Complex regional pain syndrome (CRPS) is a distressing and disabling pain condition. Many people with CRPS and the health professionals who treat them seek information about the condition via the Internet. The credibility, accuracy and comprehensiveness of online CRPS information remains unknown. The aim of this study was to determine the credibility, accuracy and comprehensiveness of information presented on freely accessible websites that aim to educate people about CRPS. Keyword searches were conducted on the Australian Google site, with 'trustworthy' websites included and critically appraised. Primary outcomes were recognised metrics of credibility (JAMA benchmark credibility criteria) and website accuracy (according to European CRPS guidelines). Comprehensiveness was assessed using the proportion of European CRPS guidelines covered by the websites. In all, 30 websites with 819 recommendations were critically appraised. Five (17%) websites met all credibility criteria; of the recommendations, 349 (43%) were accurate, 252 (31%) were inaccurate and 218 (26%) were unclear. For comprehensiveness, an average of 17% of general guidelines, 15% of therapeutic guidelines and 6% of medication/supplement guidelines were covered. Online information about CRPS available to Australians has low credibility, accuracy and comprehensiveness. Many website recommendations are inaccurate or unclear, and many websites endorse inappropriate treatments. There is an urgent need for accurate and comprehensive sources of CRPS information online.
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Affiliation(s)
- Emily Moore
- IIMPACT in Health, The University of South Australia, Adelaide, SA 5001, Australia
| | - Tasha R Stanton
- IIMPACT in Health, The University of South Australia, Adelaide, SA 5001, Australia; and Institute for Musculoskeletal Health, Camperdown, NSW 2050, Australia
| | - Adrian Traeger
- Institute for Musculoskeletal Health, Camperdown, NSW 2050, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, The University of South Australia, Adelaide, SA 5001, Australia; and Neuroscience Research Australia, Randwick, NSW 2031, Australia
| | - Carolyn Berryman
- IIMPACT in Health, The University of South Australia, Adelaide, SA 5001, Australia; and School of Biomedicine, The University of Adelaide, Adelaide, SA 5005, Australia; and South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; and Corresponding author.
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Johnston-Devin C, Oprescu F, Gray M, Wallis M. Patients Describe their Lived Experiences of Battling to Live with Complex Regional Pain Syndrome. THE JOURNAL OF PAIN 2021; 22:1111-1128. [PMID: 33892156 DOI: 10.1016/j.jpain.2021.03.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/27/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
Complex regional pain syndrome (CRPS) has never comprehensively been examined from a lived experience perspective. Patients generally have a poorer quality of life than people with other chronic pain conditions. This study aimed to understand the essence of living with CRPS. Data were collected from 17 patients via in-depth interviews. Hermeneutic discussions with four health professionals generated deeper insights. Internet blogs and a book containing patient stories were included for theme verification and triangulation. CRPS is seen as a war-like experience and five themes were identified within the battle: "dealing with the unknown enemy", "building an armoury against a moving target", "battles within the war", "developing battle plans with allies" and "warrior or prisoner of war". Patients live with a chronic pain condition and experience problems unique to CRPS such as fear of pain extending to other parts of their body. Use of the model generated by this research may assist patient/clinician interactions and guide therapeutic discussions. Support for people living with CRPS does not always exist, and some healthcare professionals require additional education about the condition. Better health outcomes are experienced by patients when their personal situation and experiences are heard and understood by health care professionals. PERSPECTIVE: This article presents the lived experience of CRPS. This information and the model generated can help clinicians to better understand their patients and deliver appropriate patient-centered care.
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Affiliation(s)
- Colleen Johnston-Devin
- School of Health and Sport Science, University of the Sunshine Coast, Sippy Downs, QLD, Australia; School of Nursing, Midwifery and Social Sciences, CQUniversity Australia, Brisbane, QLD, Australia.
| | - Florin Oprescu
- School of Health and Sport Science, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Marion Gray
- School of Health and Sport Science, University of the Sunshine Coast, Sippy Downs, QLD, Australia; School of Health and Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
| | - Marianne Wallis
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia; School of Health and Human Sciences, Southern Cross University, Bilinga, QLD, Australia
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Beales D, Carolan D, Chuah-Choong J, Hammond S, O'Brien E, Boyle E, Ranelli S, Holthouse D, Mitchell T, Slater H. Exploring peoples' lived experience of complex regional pain syndrome in Australia: a qualitative study. Scand J Pain 2021; 21:393-405. [PMID: 34387965 DOI: 10.1515/sjpain-2020-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/24/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Complex regional pain syndrome (CRPS) is a persistent pain condition which is often misunderstood and poorly managed. Qualitative studies are needed to explore the lived experience of the condition and to better understand patient perspectives on their management experiences and needs. The aim of this study was to explore the lived experience of CRPS in Australia, including exploration of their perceptions of care and advice received from healthcare professionals. METHODS A qualitative study with individual in-depth semi-structured, face-to-face interviews was performed (n=15, 80% female, average time elapsed since diagnosis 3.8 years). Qualitative data were analysed using an inductive thematic analysis approach. RESULTS Four main themes with associated subthemes were identified, representing the participants' journey: (1) Life Changing Impact of CRPS (Subthemes: Impact on self, Impact on others); (2) Variable Experiences of Care (Subthemes: Helpful experiences of care, Unhelpful experiences of care); (3) Making Sense of CRPS (Subthemes: Knowledge and understanding, Dealing with unpredictability); and (4) Perceptions on Lessons Learned from Living with CRPS (Subthemes: Acceptance was an important part of the journey, Trial and error was necessary to find an individual way forward, Coping strategies). CONCLUSIONS The themes identified align to and expand on prior qualitative research findings in people with CRPS. It highlights the challenges people face related to their personal self, their close relationships and their social and work roles. It highlights the difficulties these people have in finding reliable, trust-worthy information. These findings suggest that healthcare professionals may benefit from education about how to better support people with CRPS, including helping people to navigate to the right care. Engaging people with CRPS in the development of educational resources should be a future research goal. It is recommended that patient perspectives are incorporated into the development of care pathways for CRPS.
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Affiliation(s)
- Darren Beales
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, 6845Perth, Western Australia, Australia
| | - David Carolan
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, 6845Perth, Western Australia, Australia
| | - Joshua Chuah-Choong
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, 6845Perth, Western Australia, Australia
| | - Sarah Hammond
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, 6845Perth, Western Australia, Australia
| | - Eimear O'Brien
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, 6845Perth, Western Australia, Australia
| | - Eileen Boyle
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, 6845Perth, Western Australia, Australia
| | - Sonia Ranelli
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, 6845Perth, Western Australia, Australia
| | - David Holthouse
- Claremont Pain Clinic, 12/237 Stirling Highway, 6010Claremont, Western Australia, Australia
| | - Tim Mitchell
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, 6845Perth, Western Australia, Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, 6845Perth, Western Australia, Australia
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Boichat C, Llewellyn A, Grieve S, McCabe C. The Role of Nonmedical Therapeutic Approaches in the Rehabilitation of Complex Regional Pain Syndrome. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00156-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Purpose of the Review
Nonmedical therapeutic approaches are fundamental to the management of of Complex Regional Pain Syndrome (CRPS) in order to promote the best outcome for patients. This review focuses on three key approaches underpinning CRPS rehabilitation, namely, physiotherapy and occupational therapy, psychological approaches and education and self-management.
Recent Findings
Recently published European standards outline the quality of therapeutic care that people with CRPS must receive. Early initiated therapy is essential to optimise outcomes, underpinned by patient education. Therapists should promote early movement of the affected limb and encourage re-engagement with usual activities as immobilisation is known to have negative outcomes. There is evidence to support the possible long-term benefit of graded motor imagery and mirror therapy. Psychological assessment should include identification of depression and post-traumatic stress disorder, as treatment of these conditions may improve the trajectory of CRPS. Novel therapies include neurocognitive approaches and those addressing spatial bias, both of which should provide a focus for future research.
Summary
There exists a broad range of nonmedical therapeutic approaches to rehabilitation for CPRS that are thought to be important. However, the evidence for their efficacy is limited. Further research using standardised outcomes would be helpful in developing targeted therapies for the future.
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Kim IS, Hyun SE, Park J, Lim JY. Understanding the Rehabilitation Needs of Korean Patients With Complex Regional Pain Syndrome. Ann Rehabil Med 2020; 44:218-227. [PMID: 32475093 PMCID: PMC7349043 DOI: 10.5535/arm.19084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/11/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the current status of pain severity and quality of life (QoL) in patients with complex regional pain syndrome (CRPS), and to assess both their perceived needs and any unmet needs of current rehabilitation services. METHODS A single-center questionnaire-based survey was conducted on 47 patients with CRPS who were diagnosed based on Budapest's criteria. It collected demographic and clinical data, and the structured questionnaire included the Brief Pain Inventory (BPI), the Korean version of the World Health Organization Disability Assessment Schedule II (WHODAS-K II), as well as the 5-Level EuroQol-5D (EQ-5D-5L) for measuring the QoL. RESULTS The average value of BPI and WHODAS-K II were 7.69%±2.26% and 70.49%±19.22%, respectively. In the evaluation of their perceived needs and unmet needs for rehabilitation, patients had the highest rehabilitation needs in terms of pain (95.74%), followed by bodyaches (80.85%). Regarding their unmet needs, patients had the highest unmet needs in terms of memory impairment (83.33%), followed by weight management (72.00%). According to the regression analysis, only the overall BPI was significantly associated with QoL (p=0.01), and a higher BPI value led to poorer results for QoL. CONCLUSION In Korea, patients with CRPS do not receive adequate rehabilitation, and they are not satisfied with current received treatments. A more structured and individualized rehabilitation treatment plan is required to manage every aspect related to chronic pain, and provision should be made for improved care guidelines for future CRPS management.
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Affiliation(s)
- In Soo Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Eun Hyun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jihong Park
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Packham T, Holly J. Mechanism-specific rehabilitation management of complex regional pain syndrome: Proposed recommendations from evidence synthesis. J Hand Ther 2019; 31:238-249. [PMID: 29452930 DOI: 10.1016/j.jht.2018.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Narrative review. INTRODUCTION There are a variety of treatments with demonstrated effectiveness for the management of complex regional pain syndrome (CRPS). However given the variability in symptom presentation in this population, therapists may be unsure what treatments would be most effective for individual clients. PURPOSE OF THE STUDY To present a brief synthesis of the literature and propose a rehabilitation version of a mechanism-specific management algorithm to guide personalized treatment of CRPS. METHODS A systematic search of the literature was conducted to identify all randomized controlled trials, systematic reviews, and clinical practice guidelines addressing rehabilitation of CRPS. Results were reviewed independently by 2 reviewers and final selection of articles was reached by consensus, Data was extracted using standardized forms, and a single rater gave quality ratings. Both reviewers then used the extracted data to present a synthesis of the evidence categorized by the proposed mechanisms of effect. RESULTS A total of 111 articles were retrieved and reviewed for inclusion; 49 were selected for data extraction. A synthesis of the key recommendations was compiled into a rehabilitation-specific version of the mechanism-based management algorithm proposed by Gierthmühlen et al (2014). CONCLUSIONS Consideration of mechanism-appropriate rehabilitation interventions may assist therapists to select the most appropriate and effective treatments from the body of evidence supporting rehabilitation of CRPS.
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Affiliation(s)
- Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada.
| | - Janet Holly
- The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Misidou C, Papagoras C. Complex Regional Pain Syndrome: An update. Mediterr J Rheumatol 2019; 30:16-25. [PMID: 32185338 PMCID: PMC7045919 DOI: 10.31138/mjr.30.1.16] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/06/2019] [Accepted: 01/21/2019] [Indexed: 12/18/2022] Open
Abstract
Complex regional pain syndrome (CRPS) is a perplexing painful syndrome of the extremities usually following a harmful event. It is distinguished in two types, mainly depending on the presence of nerve injury. Although its prevalence may vary depending on social and ethnic factors, middle-aged women seem to suffer most often and the upper limb is the most commonly affected extremity. Apart from pain, which is the dominating feature, the clinical picture unfolds across several domains: sensory, motor, autonomic and trophic. This syndrome develops in two phases, the acute (warm) phase, with the classic symptoms of inflammation, and the chronic (cold) phase, often characterized by trophic changes of the soft tissues and even bones. Although the syndrome has been studied for over two decades, no imaging or laboratory test has been established for the diagnosis and recently proposed diagnostic criteria have not yet been validated and are only occasionally applied. Its pathophysiology is still quite obscure, although the most likely mechanisms involve the classic and neurogenic paths of inflammation mediated by cytokines and neuropeptides, intertwined with changes of the autonomic and central nervous system, psychological mechanisms and, perhaps, autoimmunity. Although plenty of treatment modalities have been tried, none has been proven unequivocally efficacious. Apart from information and education, which should be offered to all patients, the most effective pharmacological treatments seem to be bisphosphonates, glucocorticoids and vasoactive mediators, while physical therapy and rehabilitation therapy also make part of the treatment.
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Affiliation(s)
- Christina Misidou
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Charalampos Papagoras
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Shepherd M, Louw A, Podolak J. The clinical application of pain neuroscience, graded motor imagery, and graded activity with complex regional pain syndrome-A case report. Physiother Theory Pract 2018; 36:1043-1055. [PMID: 30499359 DOI: 10.1080/09593985.2018.1548047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic Regional Pain Syndrome (CRPS) is a condition that physical therapists may encounter in an outpatient orthopedic setting. In physical therapy (PT) treatment of CRPS addresses pain and the changes observed in the brain through the use of graded motor imagery (GMI). CASE DESCRIPTION A 57-year-old female presented to an outpatient PT clinic with CRPS type 1. Complicating psychosocial factors such as kinesiophobia and catastrophization were present. The patient engaged in a treatment plan including GMI: pain neuroscience education (PNE), laterality training, motor imagery, and mirror training. As symptoms improved, graded functional exposure and functional restoration occurred. OUTCOMES The patient was seen for a total of 26 visits over a 9-month period. FAAM measures exceeded reported clinically important change that was sustained at two-year follow-up. Long term outcomes showed no functional deficits related to her foot or ankle and minimal to no catastrophizing and fear avoidance behaviors. DISCUSSION This case report showcases the use of GMI with a patient with CRPS type 1 in an outpatient orthopedic clinic. Clinicians may consider the use of GMI to progress a patient toward maximal functional gains.
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Affiliation(s)
- Mark Shepherd
- Department of Physical Therapy, South College , Knoxville, TN, USA.,Evidence in Motion Institute of Health Professions , Louisville, KY, USA
| | - Adriaan Louw
- International Spine and Pain Institute , Louisville, KY, USA
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Navarro K, Wainwright E, Rodham K, Jordan A. Parenting young people with complex regional pain syndrome: an analysis of the process of parental online communication. Pain Rep 2018; 3:e681. [PMID: 30324173 PMCID: PMC6172825 DOI: 10.1097/pr9.0000000000000681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/01/2018] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Parenting a young person with complex regional pain syndrome (CRPS) is associated with high levels of parental distress and numerous emotional, informational, and practical challenges. To meet these challenges, parents seek others undergoing similar experiences, both in face to face and online forums. OBJECTIVES The objective of this study was to conduct a qualitative analysis of online forum data to explore the process of parental forum communication regarding parenting a young person with CRPS in online spaces. METHODS A total of 107 forum posts relating to parenting a young person with CRPS were collected from 39 users across 2 public forums. Data were analyzed using thematic analysis. RESULTS Findings identified 2 themes: "the informal rules of exchanging and receiving network support" and "parents positioning themselves as experts." The first theme highlighted the varied nature of support sought and provided by parents in addition to social rules associated with the negotiation of this support. The second theme represented an understanding of how parents presented themselves as experts in their young person's pain, both in relation to fellow parents and health care professionals. CONCLUSION This study provided a novel insight into support and communicational exchanges between parents of young people with CRPS on online public forums. Findings identified the perceived usefulness of online spaces in terms of parents of young people with CRPS seeking and providing support. Further research can helpfully investigate how we might implement online peer mentoring to improve support further for parents.
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Affiliation(s)
- Kaedi Navarro
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Elaine Wainwright
- Department of Psychology, Bath Spa University, Bath, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
| | - Karen Rodham
- Department of Psychology, Staffordshire Centre for Psychological Research, Staffordshire University, Stoke on Trent, United Kingdom
| | - Abbie Jordan
- Department of Psychology and Centre for Pain Research, University of Bath, Bath, United Kingdom
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Qualitative pain research emphasizes that patients need true information and physicians and nurses need more knowledge of complex regional pain syndrome (CRPS). Scand J Pain 2017; 15:104-105. [PMID: 28850331 DOI: 10.1016/j.sjpain.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
In this issue of the Scandinavian Journal of Pain Kari Sørensen and Bjørg Christiansen publish their report on in depth interviews of young patients suffering from CRPS or from severe muscle pain [1]. These patients were recovering from their chronic pain conditions after treatment by a multidisciplinary rehabilitation team.
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Galve Villa M, Rittig-Rasmussen B, Moeller Schear Mikkelsen L, Groendahl Poulsen A. Complex regional pain syndrome. ACTA ACUST UNITED AC 2016; 26:223-230. [PMID: 27491326 DOI: 10.1016/j.math.2016.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Complex regional pain syndrome (CRPS) is a chronic pain condition that can occur after a minor trauma or surgery. It is a multifactorial condition with a complex cause and even more complex pathophysiology. There are disturbances and changes in the sympathetic, somatosensory and motor nervous system, resulting in severe pain and disability. Patients with CRPS can have their quality of life and functional ability greatly affected and they need appropriate and interdisciplinary interventions. PURPOSE This article contributes towards an up-to-date knowledge and an overall view of CRPS, which can contribute to a structured and systematic rehabilitation process for patients. IMPLICATIONS This Masterclass describes a functional restoration algorithm to assist therapists in the development of a treatment plan based on the available evidence and international guidelines. Early diagnosis and treatment is of great importance as patients (adults and children), can be severely affected in their functional capacity and quality of life.
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Affiliation(s)
- Maria Galve Villa
- Pain and Headache Clinic, Aarhus University Hospital, Noerrebrogade 44, Building 1A, 8000 Aarhus C, Denmark.
| | | | - Lene Moeller Schear Mikkelsen
- The Multidisciplinary Pain Center, Copenhagen University Hospital, Rigshospitalet, Afsnit 7612, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne Groendahl Poulsen
- Surgical Therapy Department, Regional Hospital Silkeborg, Falkevej 1-3, 8600 Silkeborg, Denmark
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