Complex regional pain syndrome: advancing rehabilitation through better evaluation and treatment Thesis uri icon

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  • Overview
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abstract

  • Introduction: Complex regional pain syndrome (CRPS) is a form of neuropathic pain that sometimes develops after trauma or surgery. While diagnostic criteria have been debated, there is agreement participation in rehabilitation should be the primary management. However, there are gaps in the evidence guiding assessment and treatment choices for individuals with CRPS. The purpose of this thesis was to advance the rehabilitation of CRPS by 1) ongoing development and refinement of evaluations for the specific symptoms of CRPS, and 2) to investigate effectiveness of a new treatment (somatosensory rehabilitation) posited to address allodynia associated with CRPS. Methods: We conducted a series of 4 studies addressing various aspects of CRPS assessment and the somatosensory rehabilitation method: a) a cognitive debriefing study for content validation of the Patient-Reported Hamilton Inventory for CRPS; b) English translation and cultural validation of the Radboud Evaluation of Sensitivity; c) a retrospective cohort study of the effectiveness of somatosensory rehabilitation for allodynia in the upper limb; and d) a pilot study of the somatosensory rehabilitation method to consider the measurement properties of the embedded evaluation tools of allodynography and the rainbow pain scale, and to provide estimates for future controlled trials of effectiveness. Results: The cognitive debriefing study identified potentially problematic items, and constructs which needed enhancement in future versions of the PR-HICRPS assessment. The second paper reported the translation and cultural validation of the RES-E, finding support for test-retest reliability, internal consistency, and preliminary evidence for construct validity and reproducibility. The third paper presented preliminary evidence of a strong effect size for the SRM in an uncontrolled consecutive cohort. Finally, the fourth paper provides an interm analysis of the psychometric properties of allodynography and the rainbow pain scale, and estimates large sample sizes will be required for future trials. Discussion and Conclusion: None of the assessment tools described herein is ready for unrestricted use in clinical practice or research. Although the effect size estimates for somatosensory rehabilitation from the retrospective cohort are encouraging, the incomplete pilot data suggests large, multi-site trials and careful selection of the primary outcome measures will be required for future, rigorous trials of this method.

publication date

  • 2016