Understanding the biopsychosocial impacts of living with Complex Regional Pain Syndrome

Llewellyn, Alison; Sweeting, Mary-Jane; McCabe, Candy

Abstract

Background:
Complex Regional Pain Syndrome (CRPS) is a disabling pain condition which commonly follows trauma to a limb, although the exact aetiology is currently unknown. It is characterised by severe, unremitting pain; autonomic, motor and sensory changes; and disrupted body perception[1,2]. While the signs and symptoms of CRPS are well documented, the wider bio-psychosocial consequences of living with CRPS have received less attention. Understanding these broader impacts has important implications for treatment and rehabilitation services.

Method:
In a prior Delphi study, participants (≥18 years, and who met the Budapest diagnostic criteria for CRPS) were recruited via 10 centres across 8 in order to define recovery from CRPS, from the patient perspective[3]. In free text responses, participants however also described the wider bio-psychosocial impacts of the condition. The current study presents results from a secondary qualitative analysis of these latter data, using inductive thematic analysis to identify the bio-psychosocial impacts of the condition.

Results:
Data were provided by 347 participants from which five superordinate themes were elicited: life being less than previously, impacts on identity, physical consequences, psychological distress, and coping strategies. Within these themes participants described the many impacts of CRPS, including how quality of life is diminished, participation and independence is restricted and social roles are affected. They also reported decrements in self-esteem, self-image and identity, and adverse effects on mood. Reported physical consequences beyond the diagnostic criteria were noted, including fatigue, poor cognition and medication side-effects. Practical and creative positive coping strategies were however also reported.

Conclusions
These findings highlight the multi-dimensional nature of the bio-psychosocial impacts of CRPS. There is a need for clinicians to be mindful to use person-centred approaches in which the impacts of therapeutic interventions for CRPS on psychological wellbeing are considered, as well the effects on physical function outcomes.

References

1. Harden, R.N., Bruehl, S., Perez, R.S., Birklein, F., Marinus, J., Maihofner, C., Lubenow, T., Buvanendran, A., Mackey, S., Graciosa, J. and Mogilevski, M., 2010. Validation of proposed diagnostic criteria (the “Budapest Criteria”) for complex regional pain syndrome. Pain, 150(2), pp.268-274.

2. Lewis, J.S., Kersten, P., McCabe, C.S., McPherson, K.M. and Blake, D.R., 2007. Body perception disturbance: a contribution to pain in complex regional pain syndrome (CRPS). PAIN, 133(1-3), pp.111-119.

3. Llewellyn, A., McCabe, C.S., Hibberd, Y., White, P., Davies, L., Marinus, J., Perez, R.G.S.M., Thomassen, I., Brunner, F., Sontheim, C. and Birklein, F., 2018. Are you better? A multi‐centre study of patient‐defined recovery from Complex Regional Pain Syndrome. European journal of pain, 22(3), pp.551-564.

• Presentation Conference Type: Poster
• Conference Name: UWE Centre for Health and Clinical Research Showcase Conference
• Start Date: Apr 5, 2019
• End Date: Apr 5, 2019
• Acceptance Date: Feb 27, 2019
• Publicly Available Date: Jun 6, 2019
• Peer Reviewed: Not Peer Reviewed
• Keywords: Complex Regional Pain Syndrome, biopsychosocial, chronic pain
• Public URL: https://uwe-repository.worktribe.com/output/851697
• Additional Information: Title of Conference or Conference Proceedings : University of the West of England Centre for Health and Clinical Research Showcase Conference