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Turgeman Dahan N, Vatine JJ, Weissman-Fogel I, Karpin H, Shmuely S, Bar-Shalita T. Quantitative Dynamic Allodynograph-A Standardized Measure for Testing Dynamic Mechanical Allodynia in Chronic Limb Pain. SENSORS (BASEL, SWITZERLAND) 2023; 23:7949. [PMID: 37766006 PMCID: PMC10535773 DOI: 10.3390/s23187949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/18/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Dynamic mechanical allodynia (DMA) is both a symptom and a central sensitization sign, yet no standardized method for quantifying the DMA area has been reported. This study aimed to establish psychometric properties for Quantitative Dynamic Allodynography (QDA), a newly developed protocol measuring the DMA area as a percentage of the body surface. METHODS Seventy-eight patients aged 18-65 diagnosed with chronic complex regional pain syndrome (CRPS) participated in this study. Test-retest reliability was conducted twice, one week apart (N = 20), and inter-rater (N = 3) reliability was conducted on 10 participants. Disease severity (CRPS Severity Score, CSS), pain intensity (VAS), and quality of life (SF-36) measures were utilized to test construct validity. RESULTS High inter-rater reliability (intraclass correlation coefficient (ICC) = 0.96, p < 0.001) and test-retest reliability (r = 0.98, p < 0.001) were found. Furthermore, the QDA score was found to be correlated with the CSS (r = 0.47, p < 0.001), VAS (r = 0.37, p < 0.001), and the SF-36 physical health total (r = -0.47, p < 0.001) scores. CONCLUSION The QDA is the first developed reliable and valid protocol for measuring DMA in a clinical setting and may be used as a diagnostic and prognostic measure in clinics and in research, advancing the pain precision medicine approach.
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Affiliation(s)
- Noy Turgeman Dahan
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 69978, Israel;
- Reuth Rehabilitation Hospital, Tel Aviv-Yafo 6772830, Israel; (H.K.); (S.S.)
| | | | - Irit Weissman-Fogel
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3103301, Israel;
| | - Hana Karpin
- Reuth Rehabilitation Hospital, Tel Aviv-Yafo 6772830, Israel; (H.K.); (S.S.)
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3103301, Israel;
| | - Sharon Shmuely
- Reuth Rehabilitation Hospital, Tel Aviv-Yafo 6772830, Israel; (H.K.); (S.S.)
| | - Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 69978, Israel;
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John H, Lim YH, Hong SJ, Jeong JH, Choi HR, Park SK, Kim JE, Kim BS, Kim JH. Impact of coronavirus disease 2019 on patients with chronic pain: multicenter study in Korea. Korean J Pain 2022; 35:209-223. [PMID: 35354684 PMCID: PMC8977200 DOI: 10.3344/kjp.2022.35.2.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has caused significant changes. This study aimed to investigate the impact of COVID-19 on patients with chronic pain. Methods Patients with chronic pain from 23 university hospitals in South Korea participated in this study. The anonymous survey questionnaire consisted of 25 questions regarding the following demographic data, diagnosis, hospital visit frequency, exercise duration, time outside, sleep duration, weight change, nervousness and anxiety, depression, interest or pleasure, fatigue, daily life difficulties, and self-harm thoughts. Depression severity was evaluated using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression analysis was used to investigate the relationship between increased pain and patient factors. Results A total of 914 patients completed the survey, 35.9% of whom had decreased their number of visits to the hospital, mostly due to COVID-19. The pain level of 200 patients has worsened since the COVID-19 outbreak, which was more prominent in complex regional pain syndrome (CRPS). Noticeable post-COVID-19 changes such as exercise duration, time spent outside, sleep patterns, mood, and weight affected patients with chronic pain. Depression severity was more significant in patients with CRPS. The total PHQ-9 average score of patients with CRPS was 15.5, corresponding to major depressive orders. The patients’ decreased exercise duration, decreased sleep duration, and increased depression were significantly associated with increased pain. Conclusions COVID-19 has caused several changes in patients with chronic pain. During the pandemic, decreased exercise and sleep duration and increased depression were associated with patients’ increasing pain.
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Affiliation(s)
- Hyunji John
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yun Hee Lim
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sung Jun Hong
- Department of Anesthesiology and Pain Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jae Hun Jeong
- Department of Anesthesiology and Pain Medicine, Jeong-clinic, Seoul, Korea
| | - Hey Ran Choi
- Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Sun Kyung Park
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Jung Eun Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Byung-Soo Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Lee J, Lim YH, Hong SJ, Jeong JH, Choi HR, Park SK, Kim JE, Park EH, Kim JH. Multicenter survey of symptoms, work life, economic status, and quality of life of complex regional pain syndrome patients. Korean J Pain 2021; 34:288-303. [PMID: 34193635 PMCID: PMC8255153 DOI: 10.3344/kjp.2021.34.3.288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 11/21/2022] Open
Abstract
Background Complex regional pain syndrome (CRPS) is an intractable pain disease with various symptoms. Here, we investigated the disease status, work life, sleep problems, medical insurance, economic status, psychological problems, and quality of life (QOL) of CRPS patients. Methods CRPS patients from 37 university hospitals in South Korea were surveyed. The survey questionnaire consisted of 24 questions on the following aspects of CRPS patients sex, age, occupation, cause of injury, activities of daily living (ADL), pain severity, sleep disturbance, level of education, economic status, therapeutic effect, and suicidal ideation. Additionally, the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions, was used to identify the status of QOL. Results A total of 251 patients completed the questionnaire. According to the survey, 54.2% patients could not perform ADL on their own. Over the previous week, the mean pain score was 7.15 ± 1.78 (out of a total of 10 points); 92.1% of patients had sleep disorders and 80.5% had suicidal ideation, with most patients suffering from psychological problems. The average for each domain of WHOQOL-BREF was as follows 21.74 ± 14.77 for physical, 25.22 ± 17.66 for psychological, 32.02 ± 22.36 for social relationship, and 30.69 ± 15.83 for environmental (out of a total of 100 points each). Occupation, ADL, sleep time, therapeutic effect, and suicidal ideation were statistically correlated with multiple domains. Conclusions Most patients had moderate to severe pain, economic problems, limitations of their ADL, sleep problems, psychological problems, and a low QOL score.
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Affiliation(s)
- Jaemoon Lee
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yun Hee Lim
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sung Jun Hong
- Department of Anesthesiology and Pain Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jae Hun Jeong
- Department of Anesthesiology and Pain Medicine, Jeong-clinic, Seoul, Korea
| | - Hey Ran Choi
- Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Sun Kyung Park
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Jung Eun Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Eun Hi Park
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Firat M. Complex regional pain syndrome type 1 of the upper limb following glass cut of the third finger in a patient. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2021. [DOI: 10.4103/jotr.jotr_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Prednisone for Acute Complex Regional Pain Syndrome: A Retrospective Cohort Study. Pain Res Manag 2020; 2020:8182569. [PMID: 32184912 PMCID: PMC7060858 DOI: 10.1155/2020/8182569] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/04/2020] [Indexed: 12/27/2022]
Abstract
Objective The objective of this study was to evaluate prednisone effectiveness on complex regional pain syndrome (CRPS) features in a community-based outpatient rehabilitation setting. Design A single-centre, retrospective inception cohort design was used. Inclusion criteria were CRPS diagnosis according to the Budapest criteria, involvement of multiple joints, treatment with prednisone, and duration of symptoms less than one year. Typical prednisone treatment was 28-day taper regimen with 60 mg. Patient symptoms and signs were compared before and after treatment. Results There were 39 patients who met inclusion criteria for analysis. Duration of symptoms before treatment was 80.8 ± 67.7 days. Following treatment, 19 (48.7%) patients reported complete pain resolution, 19 (48.7%) patients reported decreased pain permitting functional use, and 1 (2.6%) patient reported no improvement. All symptoms and signs decreased significantly following oral prednisone treatment (p < 0.001). Range of motion (ROM) deficits persisted in 19 (49%) patients. However, 17 of these patients reported functional ROM recovery. Degree of ROM recovery and time-to-treatment had low positive correlation (r = 0.354, p < 0.001). Range of motion (ROM) deficits persisted in 19 (49%) patients. However, 17 of these patients reported functional ROM recovery. Degree of ROM recovery and time-to-treatment had low positive correlation (. Conclusions These data support short-course prednisone treatment for acute and subacute CRPS with multijoint involvement in a community rehabilitation setting. The association between time-to-treatment and ROM recovery suggests earlier treatment may result in improved ROM outcomes.
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Quintal I, Poiré-Hamel L, Bourbonnais D, Dyer JO. Management of long-term complex regional pain syndrome with allodynia: A case report. J Hand Ther 2019; 31:255-264. [PMID: 29706199 DOI: 10.1016/j.jht.2018.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Case report. INTRODUCTION Conventional rehabilitation alone may not be effective in reducing symptoms in some patients with complex regional pain syndrome. PURPOSE OF THE STUDY This case report portrays the benefits of a new tailored rehabilitation program for a 39-year-old patient suffering from upper limb complex regional pain syndrome with severe touch-evoked pain (static mechanical allodynia). METHODS This patient had previously received conventional rehabilitation for a year and a half including physical and nonsurgical medical interventions that did not improve symptoms or function. In the search for an alternative, this patient was referred to occupational therapy to try a tailored rehabilitation program, drawing on multiple strategies used sequentially according to the patient's tolerance and symptom evolution. During this 22-month program, the following methods were added (listed chronologically): somatosensory rehabilitation of pain method, graded motor imagery, pain management modalities, active mobilizations, strengthening exercises, and task simulation. The patient successively showed resolution of mechanical allodynia, decreased pain, reduction of tactile hypesthesia and improvement in active range of motion, strength, and function. These improvements allowed him to return to work. DISCUSSION This suggests that a tailored rehabilitation program combining somatosensory rehabilitation of pain method, graded motor imagery and more conventional approaches could improve symptoms and functional status in patients with upper limb complex regional pain syndrome, even with persistent refractory symptoms. CONCLUSION The addition of the somatosensory rehabilitation of pain method and the graded motor imagery approach to conventional therapy could be considered in cases of complex regional pain syndrome that do not respond to conventional rehabilitation alone.
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Affiliation(s)
- Isabelle Quintal
- School of Rehabilitation, Université de Montréal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada; Centre Professionnel d'Ergothérapie, Montreal, Quebec, Canada
| | | | - Daniel Bourbonnais
- School of Rehabilitation, Université de Montréal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Joseph-Omer Dyer
- School of Rehabilitation, Université de Montréal, Quebec, Canada.
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Mouraux D, Lenoir C, Tuna T, Brassinne E, Sobczak S. The long-term effect of complex regional pain syndrome type 1 on disability and quality of life after foot injury. Disabil Rehabil 2019; 43:967-975. [PMID: 31411910 DOI: 10.1080/09638288.2019.1650295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To study the long-term evolution of patients with lower-limb Complex Regional Pain Syndrome (CRPS), focusing on functional and proprioceptive aspects and quality of life. METHODS In 20 patients suffering from chronic distal lower-limb CRPS diagnosed using Budapest criteria, we assessed joint position sense and strength of the knee muscles at the CRPS and unaffected leg, functional exercise capacity, pain, CRPS severity score, quality of life and kinesiophobia. Similar assessments were performed in 20 age-matched controls. RESULTS The joint position performance (at 45°) was significantly lower for the CRPS leg as compared to controls. The knee extensor strength of the CRPS leg was significantly reduced as compared to the unaffected leg (-27%) and controls (-42%). CRPS patients showed significantly reduced performance at the 6 min-walk test as compared to their age group predicted value and controls. Patients suffering from CRPS for 3.8 years in average still exhibit high pain, severity and kinesiophobia scores. CONCLUSIONS Long-term deficits in strength and proprioceptive impairments are observed at the knee joint of the CRPS leg. This persistent functional disability has significant repercussions on the quality of life. We highlight the importance of including strength and proprioceptive exercises in the therapeutic approaches for CPRS patients.IMPLICATIONS FOR REHABILITATIONThe long-term evolution of patients suffering from lower-limb Complex Regional Pain Syndrome is associated with persistent disability, pain and impacts the quality of life.Strength, proprioceptive, functional and subjective assessments are necessary to better identify deficits.Rehabilitation should focus on the overall deficit of the affected and contralateral limb.
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Affiliation(s)
- Dominique Mouraux
- Department of Physical Therapy and Rehabilitation, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Physiotherapy, Faculté Des Sciences de la Motricité, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Cédric Lenoir
- Department of Neuroscience, Physiology and Pharmacology, University College, London, UK.,Institut of Neuroscience, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Turgay Tuna
- Department of Anaesthesiology, Pain Clinic, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Eric Brassinne
- Department of Physical Therapy and Rehabilitation, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Physiotherapy, Faculté Des Sciences de la Motricité, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Stéphane Sobczak
- Département D'anatomie, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Canada.,Groupe de Recherche Sur Les Affections Neuro-Musculo-Squelettiques (GRAN), Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Canada
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van Bussel CM, Stronks DL, Huygen FJPM. Clinical Course and Impact of Complex Regional Pain Syndrome Confined to the Knee. PAIN MEDICINE 2019; 20:1178-1184. [PMID: 30776297 DOI: 10.1093/pm/pnz002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Although complex regional pain syndrome (CRPS) of the knee is comparable to CRPS of the ankle/foot at time of diagnosis, no reports are available concerning the course of knee CRPS. Therefore, this study investigated the clinical course in terms of the symptoms and signs, health-related quality of life (HR-QoL), and work status of patients diagnosed with CRPS of the knee. DESIGN Observational, descriptive study. SETTING Single-center study. SUBJECTS Patients with CRPS of the knee. METHODS Patients self-reported their past and current CRPS symptoms, HR-QoL, and work status; all underwent a physical examination. A comparison was made of changes in symptoms over time between patients with CRPS of the knee and those with CRPS of more distal locations. RESULTS In total, 32 patients were enrolled. The follow-up time was 11.5 ± 6.29 years since diagnosis, and symptoms and signs showed a significant decrease over time. Twelve patients (37.5%) rated their health as (generally) positive. Patients who were still able to work (31.3%) stated that their physical health gave them at least some problems in the performance of their job. A change in symptoms occurred significantly less often in CRPS of the knee. CONCLUSIONS CRPS of the knee changes in terms of symptoms over time, but significantly less than CRPS of other locations. A change in work status was reported in 82% of the patients due to their CRPS, and in 91%, the pain interfered with their daily life. CRPS of the knee is a painful condition with persistent symptoms causing a diminished HR-QoL.
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Affiliation(s)
- Catelijne M van Bussel
- Center for Pain Medicine, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Dirk L Stronks
- Center for Pain Medicine, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Frank J P M Huygen
- Center for Pain Medicine, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
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Lee JW, Lee SK, Choy WS. Complex Regional Pain Syndrome Type 1: Diagnosis and Management. J Hand Surg Asian Pac Vol 2018; 23:1-10. [DOI: 10.1142/s2424835518300013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Diagnosis of Complex regional pain syndrome (CRPS) is made primarily on a clinical basis, and no specific test is known to confirm or exclude CRPS diagnosis. That is, there aren’t specific diagnostic tools and instrumental tests are made only for identifying an etiology at the basis of the CRPS. Numerous therapeutic methods have been introduced, but none have shown definitive results. When symptoms persist, patients experience permanent impairment and disability. Therefore, early recognition of CRPS, along with proper treatment, is important for minimizing permanent loss of function. As there is no gold standard test for CRPS, several clinical diagnostic criteria have been introduced and applied in various studies. However, to date, no formal or standardized diagnostic criteria for CRPS have been widely accepted. However, the Budapest diagnostic criteria have recently increased in popularity and are frequently used in scientific studies. The goal for management of CRPS is the return of normal limb function. No specific technique has been shown to prevent CRPS following surgery, but avoidance of prolonged immobilization may be important. Therefore, initiating early post-surgical rehabilitation, where possible, is important. A multidisciplinary approach would seem to be optimal, above all things objectives of physical and occupational therapy are fulfilled with combination pharmacotherapy due to provide pain relief to facilitate physical rehabilitation. Future research using large randomized controlled trials should focus on collecting strong evidence for the etiology of CRPS, testing pharmacological effects, and determining appropriate combination treatment strategies.
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Affiliation(s)
- Jae Won Lee
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Sang Ki Lee
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Won Sik Choy
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
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Sensitization of the Nociceptive System in Complex Regional Pain Syndrome. PLoS One 2016; 11:e0154553. [PMID: 27149519 PMCID: PMC4858201 DOI: 10.1371/journal.pone.0154553] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 04/17/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Complex regional pain syndrome type I (CRPS-I) is characterized by sensory, motor and autonomic abnormalities without electrophysiological evidence of a nerve lesion. OBJECTIVE Aims were to investigate how sensory, autonomic and motor function change in the course of the disease. METHODS 19 CRPS-I patients (17 with acute, 2 with chronic CRPS, mean duration of disease 5.7±8.3, range 1-33 months) were examined with questionnaires (LANSS, NPS, MPI, Quick DASH, multiple choice list of descriptors for sensory, motor, autonomic symptoms), motor and autonomic tests as well as quantitative sensory testing according to the German Research Network on Neuropathic Pain at two visits (baseline and 36±10.6, range 16-53 months later). RESULTS CRPS-I patients had an improvement of sudomotor and vasomotor function, but still a great impairment of sensory and motor function upon follow-up. Although pain and mechanical detection improved upon follow-up, thermal and mechanical pain sensitivity increased, including the contralateral side. Increase in mechanical pain sensitivity and loss of mechanical detection were associated with presence of ongoing pain. CONCLUSIONS The results demonstrate that patients with CRPS-I show a sensitization of the nociceptive system in the course of the disease, for which ongoing pain seems to be the most important trigger. They further suggest that measured loss of function in CRPS-I is due to pain-induced hypoesthesia rather than a minimal nerve lesion. In conclusion, this article gives evidence for a pronociceptive pain modulation profile developing in the course of CRPS and thus helps to assess underlying mechanisms of CRPS that contribute to the maintenance of patients' pain and disability.
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Factors Associated With Disability and Sick Leave in Early Complex Regional Pain Syndrome Type-1. Clin J Pain 2016; 32:130-8. [DOI: 10.1097/ajp.0000000000000234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Thieme H, Morkisch N, Rietz C, Dohle C, Borgetto B. The Efficacy of Movement Representation Techniques for Treatment of Limb Pain--A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2015; 17:167-80. [PMID: 26552501 DOI: 10.1016/j.jpain.2015.10.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/29/2015] [Accepted: 10/14/2015] [Indexed: 11/27/2022]
Abstract
UNLABELLED Relatively new evidence suggests that movement representation techniques (ie, therapies that use the observation and/or imagination of normal pain-free movements, such as mirror therapy, motor imagery, or movement and/or action observation) might be effective in reduction of some types of limb pain. To summarize the evidence regarding the efficacy of those techniques, a systematic review with meta-analysis was performed. We searched Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsychINFO, Physiotherapy Evidence Database, and OT-seeker up to August 2014 and hand-searched further relevant resources for randomized controlled trials that studied the efficacy of movement representation techniques in reduction of limb pain. The outcomes of interest were pain, disability, and quality of life. Study selection and data extraction were performed by 2 reviewers independently. We included 15 trials on the effects of mirror therapy, (graded) motor imagery, and action observation in patients with complex regional pain syndrome, phantom limb pain, poststroke pain, and nonpathological (acute) pain. Overall, movement representation techniques were found to be effective in reduction of pain (standardized mean difference [SMD] = -.82, 95% confidence interval [CI], -1.32 to -.31, P = .001) and disability (SMD = .72, 95% CI, .22-1.22, P = .004) and showed a positive but nonsignificant effect on quality of life (SMD = 2.61, 85% CI, -3.32 to 8.54, P = .39). Especially mirror therapy and graded motor imagery should be considered for the treatment of patients with complex regional pain syndrome. Furthermore, the results indicate that motor imagery could be considered as a potential effective treatment in patients with acute pain after trauma and surgery. To date, there is no evidence for a pain reducing effect of movement representation techniques in patients with phantom limb pain and poststroke pain other than complex regional pain syndrome. PERSPECTIVE In this systematic review we synthesize the evidence for the efficacy of movement representation techniques (ie, motor imagery, mirror therapy, or action observation) for treatment of limb pain. Our findings suggest effective pain reduction in some types of limb pain. Further research should address specific questions on the optimal type and dose of therapy.
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Affiliation(s)
- Holm Thieme
- Faculty of Social Work and Health, University of Applied Sciences and Arts, Hildesheim, Germany; First European School for Physiotherapy, Occupational Therapy, and Speech and Language Therapy, Clinic Bavaria Kreischa, Kreischa, Germany.
| | - Nadine Morkisch
- MEDIAN Clinic Berlin-Kladow, Berlin, Germany; Center for Stroke Research Berlin, Charité - University Medicine Berlin, Berlin, Germany
| | - Christian Rietz
- Department of Special Education and Rehabilitation, Faculty of Human Sciences, University of Cologne, Germany
| | - Christian Dohle
- MEDIAN Clinic Berlin-Kladow, Berlin, Germany; Center for Stroke Research Berlin, Charité - University Medicine Berlin, Berlin, Germany
| | - Bernhard Borgetto
- Faculty of Social Work and Health, University of Applied Sciences and Arts, Hildesheim, Germany
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Bean DJ, Johnson MH, Heiss-Dunlop W, Kydd RR. Extent of recovery in the first 12 months of complex regional pain syndrome type-1: A prospective study. Eur J Pain 2015; 20:884-94. [PMID: 26524108 DOI: 10.1002/ejp.813] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The literature concerning the outcomes of complex regional pain syndrome (CRPS) is contradictory, with some studies suggesting high rates of symptom resolution, whilst others demonstrate that CRPS symptoms can persist and lead to significant disability. The aim of the present study was to carefully document the extent of recovery from each of the signs and symptoms of CRPS. METHODS A sample of 59 patients with recently onset (<12 weeks) CRPS-1 were followed prospectively for 1 year, during which time they received treatment-as-usual. At baseline, 6 and 12 months, the following were measured: CRPS severity scores (symptoms and signs of CRPS), pain, disability, work status and psychological functioning. RESULTS Analyses showed that rates of almost all signs and symptoms of CRPS reduced significantly over 1 year. Reductions in symptom severity were clinically relevant and were greatest in the first 6 months and plateaued thereafter. However, at 1 year, nearly 2/3 of patients continued to meet the IASP-Orlando criteria for CRPS and 1/4 met the Budapest research criteria for CRPS. Only 5.4% of patients were symptom-free at 12 months. CONCLUSIONS Overall the results were less optimistic than several previously conducted prospective studies and suggest that few cases of CRPS resolve completely within 12 months of onset. Improvements were generally greater in the first 6 months, and suggest that it may be worth exploring early interventions to prevent long-term disability in CRPS.
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Affiliation(s)
- D J Bean
- The Auckland Regional Pain Service (TARPS), Auckland District Health Board, New Zealand.,Department of Psychological Medicine, The University of Auckland, New Zealand
| | - M H Johnson
- Department of Psychological Medicine, The University of Auckland, New Zealand
| | - W Heiss-Dunlop
- Auckland Regional Plastic Reconstructive and Hand Surgery Service, Counties Manukau District Health Board, New Zealand
| | - R R Kydd
- Department of Psychological Medicine, The University of Auckland, New Zealand
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Abstract
PURPOSE To describe the physical therapy management of a pediatric patient with bilateral lower extremity complex regional pain syndrome (CRPS). CASE DESCRIPTION The participant was a 13-year-old adolescent girl who was admitted to an inpatient rehabilitation unit with bilateral lower extremity CRPS-I. Examination included assessment of lower extremity active range of motion, transfers, mobility, and completion of the Functional Independence Measure for Children (WeeFIM). Intervention consisted of gradual desensitization techniques, progressive weight bearing and mobility, functional transfer training, progressive strengthening, and cardiovascular exercises-all conducted using a modified pain exposure therapy approach. OUTCOME WeeFIM scores increased to modified independence or independent in all areas. DISCUSSION The severity of the patient's CRPS necessitated a progressive and function-based approach to physical therapy management. Motivation, a pain exposure-based approach, and a multidisciplinary team approach appeared to affect the participant's recovery of function and reintegration into school and leisure activities.
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15
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Bean DJ, Johnson MH, Kydd RR. The Outcome of Complex Regional Pain Syndrome Type 1: A Systematic Review. THE JOURNAL OF PAIN 2014; 15:677-90. [DOI: 10.1016/j.jpain.2014.01.500] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/15/2014] [Accepted: 01/29/2014] [Indexed: 11/16/2022]
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16
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Health-related quality of life in 975 patients with complex regional pain syndrome type 1. Pain 2014; 155:629-634. [DOI: 10.1016/j.pain.2013.12.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/05/2013] [Accepted: 12/10/2013] [Indexed: 11/18/2022]
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17
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Borchers A, Gershwin M. Complex regional pain syndrome: A comprehensive and critical review. Autoimmun Rev 2014; 13:242-65. [DOI: 10.1016/j.autrev.2013.10.006] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2013] [Indexed: 12/19/2022]
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18
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Bank P, van Rooijen D, Marinus J, Reilmann R, van Hilten J. Force modulation deficits in complex regional pain syndrome: A potential role for impaired sense of force production. Eur J Pain 2014; 18:1013-23. [DOI: 10.1002/j.1532-2149.2013.00446.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2013] [Indexed: 11/10/2022]
Affiliation(s)
- P.J.M. Bank
- Department of Neurology; Leiden University Medical Center; The Netherlands
- Research Institute MOVE, Faculty of Human Movement Sciences; VU University Amsterdam; The Netherlands
| | - D.E. van Rooijen
- Department of Neurology; Leiden University Medical Center; The Netherlands
| | - J. Marinus
- Department of Neurology; Leiden University Medical Center; The Netherlands
| | - R. Reilmann
- Department of Neurology; University Clinic Muenster (UKM), Westfaelische-Wilhelms-University Muenster; Germany
- George-Huntington-Institute; Muenster Germany
| | - J.J. van Hilten
- Department of Neurology; Leiden University Medical Center; The Netherlands
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19
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Abstract
Complex regional pain syndrome (CRPS) is a disabling pain condition poorly understood by medical professionals. Because CRPS is particularly enigmatic, and has significant impact on patient function, researchers have examined psychological processes present among patients with this diagnosis. This systematic review examines psychosocial factors associated with CRPS, both predictors and sequelae. Our conclusions are that CRPS is associated with negative outcomes, both psychological (e.g., increased depression and anxiety) and psychosocial (e.g., reduced quality of life, impaired occupational function) in nature. However, research does not reveal support for specific personality or psychopathology predictors of the condition.
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