Body perception disturbance and pain reduction in longstanding complex regional pain syndrome following a multidisciplinary rehabilitation program

Lewis, Jennifer S.; Kellett, Sara; McCullough, Ryan; Tapper, Ashley; Tyler, Chelsey; Viner, Maria; Palmer, Shea

Abstract

Objective
Clinical guidelines for the treatment of complex regional pain syndrome recommend multidisciplinary rehabilitation, yet limited evidence exists to support the effectiveness of this approach. Body perception disturbance, a common and debilitating feature of complex regional pain syndrome, is recommended by guidelines as important to treat. However, no study has yet explored whether disturbances change in response to multidisciplinary rehabilitation. We aimed to determine whether there is a change in body perception disturbance and pain following a two-week multidisciplinary rehabilitation program for complex regional pain syndrome.

Methods
Retrospective clinical data from complex regional pain syndrome patients who completed the program between September 2014 and December 2016 were extracted and anonymized. Data collected pre- and post rehabilitation comprising the Bath Body Perception Disturbance scale and a pain intensity numerical rating scale were analyzed.

Results
Thirty complete data sets were analyzed from a sample of 50 consecutive patient records. After the program, there was a significant reduction in body perception disturbance (p< 0.0001), strength of negative emotional feelings (p< 0.0001) and pain (p=0.0038). There was a significant correlation between a change in disturbance and pain (r= 0.44, p=0.024). No relationship was found between the duration of symptoms and changes in disturbance (r=0.04, p=0.82).

Conclusions
This study provides evidence that both body perception disturbance and pain reduce following rehabilitation. Findings suggest that targeting these disturbances may be important in reducing pain and a potentially useful measure for recovery. Controlled trials are required to confirm the effectiveness of rehabilitation and determine what factors are responsible for these reductions.

• Journal Article Type: Article
• Acceptance Date: Jun 18, 2019
• Online Publication Date: Aug 2, 2019
• Publication Date: Nov 1, 2019
• Deposit Date: Aug 7, 2019
• Publicly Available Date: Aug 3, 2020
• Journal: Pain Medicine
• Print ISSN: 1526-2375
• Electronic ISSN: 1526-4637
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 20
• Issue: 11
• Pages: 2213-2219
• DOI: https://doi.org/10.1093/pm/pnz176
• Keywords: Anesthesiology and Pain Medicine, Clinical Neurology, General Medicine, Complex Regional Pain Syndrome, Chronic Pain, Body Perception Disturbance, Multidisciplinary Rehabilitation, Clinical Outcomes
• Public URL: https://uwe-repository.worktribe.com/output/1947275
• Publisher URL: https://academic.oup.com/painmedicine/advance-article/doi/10.1093/pm/pnz176/5542897?guestAccessKey=a0490314-5fde-4deb-9325-ebd37b37cf97
• Contract Date: Aug 7, 2019