Allied healthcare professionals interventions for complex regional pain syndrome - which work? A systematic review of the literature

Friend, Glenn; Walsh, Nicola; Llewellyn, Alison

Abstract

Background/Aims
Complex regional pain syndrome (CRPS) is a severe chronic pain condition which usually occurs following limb trauma. Also associated with a range of signs and symptoms, including limb oedema, sensitivity to touch, skin colour and temperature changes, CRPS causes significant burden to individuals and society. UK 2018 guidelines for CRPS recommend early referral for therapies that encourage limb movement and use. Allied healthcare professionals (AHPs) are instrumental in delivering this early rehabilitation. The aim of this review was to explore current literature to identify non-surgical and non-pharmaceutical interventions for CRPS that are likely to be, or could be, delivered by AHPs, and to consider their therapeutic efficacy.

Methods
A systematic review of the literature was conducted between June and August 2021 using MEDLINE, Embase, Cochrane and CINAHL databases. Search terms were designed to identify studies of interventions for CRPS normally delivered by AHPs from 2010 onwards. Studies of surgical, pharmacological and psychotherapy/counselling interventions were excluded, as were those of post-stroke CRPS populations. Data were extracted for outcomes relating to pain, function, and quality of life.

Results
Following initial screening of 1,499 records, 40 articles were retained for further consideration. Of these, 14 met the inclusion criteria and were included in the review. From the data extracted, multidisciplinary rehabilitation was reported as effective in reducing pain, as was specific sensory-motor re-education using desensitisation; however, results for the efficacy of graded motor imagery on pain and function were contradictory. Neither ultrasound therapy or prism adaptation treatment were found to lead to improvements in either pain or function. Reduction in pain was a positive outcome of transcutaneous electrical stimulation (TENS) and of the use of visual illusions for people with body perception disturbance associated with CRPS. Whilst pain exposure physical therapy was associated with increased range of motion, there was no reported improvement in pain or quality of life. Low level laser therapy was found to be superior to inferential current therapy in pain reduction and range of motion. A methodological quality assessment of the studies in this review has yet to be conducted, however, it was noted that many of the studies acknowledged several limitations, not least the difficulty in recruiting a sample sufficient to demonstrate the statistical significance of indicative results.

Conclusion
Whilst there is some evidence for the efficacy of interventions for CRPS that are, or could be, delivered by AHPs, this review suggests only a small number of approaches have proved beneficial to date. A need remains for further research in order to provide guidance to support AHPs in treating this distressing condition.

• Journal Article Type: Other
• Conference Name: British Society for Rheumatology Annual Conference 2022
• Acceptance Date: Dec 8, 2021
• Online Publication Date: Apr 23, 2022
• Publication Date: 2022-05
• Deposit Date: May 23, 2022
• Journal: Rheaumatology
• Print ISSN: 1462-0324
• Publisher: Oxford University Press (OUP)
• Volume: 61
• Issue: S1
• Article Number: keac133.285
• DOI: https://doi.org/10.1093/rheumatology/keac133.285
• Keywords: Complex Regional Pain Syndrome; Therapy Interventions; Review
• Public URL: https://uwe-repository.worktribe.com/output/9561626
• Publisher URL: https://academic.oup.com/rheumatology
• Additional Information: The poster is part of a wider programme of work: ENACT-CRPS. This study is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (200753). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.