Complex Regional Pain Syndrome: An international survey of clinical practice

Grieve, Sharon; Llewellyn, Alison; Jones, Louise; Manns, Sarah; Glanville, Victoria; McCabe, Candy

Abstract

AIM OF INVESTIGATION
Complex Regional Pain Syndrome (CRPS) is a highly distressing, persistent pain condition that occurs in a limb predominantly after trauma. There is no cure but early intervention should significantly improve outcomes1. Currently there is no definition of ‘existing care’. Establishing what this looks like internationally will help inform future patient and health professional service delivery, education initiatives, and content of clinical guidelines. From our own clinical experience, we know that clinical practice varies widely, at a local level, nationally and internationally. International guidelines2,3,4 promote best practice in CRPS treatment and management however, recommendations are not always applied in clinical practice. To gain an insight into routine CRPS clinical practice and better understand what care is being delivered across the globe, we conducted an international, online survey of clinical practice. Specifically, we wished to understand how care was being provided including clinicians’ and patients’ access to resources and expertise. We also wished to establish the aims of treatment, as defined by survey respondents, and identify the barriers and facilitators which may impact on achieving these objectives.

METHODS
An online survey was created using the Qualtrics Platform. Health professionals and researchers were recruited from an international population via the International Association for the Study of Pain (IASP) Special Interest Group for CRPS, country specific Pain Societies and health professional organisations. The survey was open through September and October 2016.
Twenty-one quantitative questions identified respondent characteristics, experience and local provision of care. Data were analysed using frequency counts and percentages. Thematic analysis identified the patterns arising from five qualitative questions; asking respondents for their treatment aims and experience in achieving these. Ethical approval was granted by the Research Ethics Committee at the University of the West of England, Bristol, UK. Participants were required to indicate their consent prior to being able to view the questionnaire. Responses were anonymous.

RESULTS
Responses were received from 271 health professionals or researchers working in 37 countries, with the highest proportions of returns from Canada (13%), New Zealand (11%) and United Kingdom (11%). The majority were clinicians providing patient care (77%) and many worked in more than one specialism. 48% of respondents reported seeing ≤5 patients with CRPS in the previous 12 months. 50% of respondents expressed difficulty in recognising the symptoms of CRPS. At the first consultation, 90% of respondents reported that, on average, their patients’ signs and symptoms had been present for ≤12 months. Treatment aims were in line with published guidelines however lack of resources and fragmented care were reported as barriers to early intervention. Five themes emerged from the qualitative data: the value of inter-disciplinary working; symptom management; need for early diagnosis and intervention; collaborative partnership with patients; the importance of education for patients and health professionals.

CONCLUSIONS
This international survey provided new insights into routine CRPS practice across the globe. Inter-disciplinary working supported the attainment of treatment aims, and opportunities to engage with colleagues across disciplines and build networks outside of the immediate clinical environment,
should be facilitated. This is particularly important for those practitioners who see patients with CRPS infrequently. Increased awareness and recognition of CRPS signs and symptoms by health professionals may be addressed by improved educational resources and access to professional networks which signpost best-practice guidelines. Although the patients seen by our respondents were, on average, assessed early in their CRPS, the reported delays in diagnosis, treatment and appropriate referral, need to be addressed by streamlining services and developing clear care pathways. Ongoing development of CRPS standards of care will undoubtedly support improved clinical effectiveness.

Citation

Grieve, S., Llewellyn, A., Jones, L., Manns, S., Glanville, V., & McCabe, C. (2018, September). Complex Regional Pain Syndrome: An international survey of clinical practice. Poster presented at International Association for the Study of Pain 17th World Congress on Pain, Boston, USA

• Presentation Conference Type: Poster
• Conference Name: International Association for the Study of Pain 17th World Congress on Pain
• Conference Location: Boston, USA
• Start Date: Sep 12, 2018
• End Date: Sep 16, 2018
• Acceptance Date: Apr 27, 2018
• Publicly Available Date: Jun 7, 2019
• Peer Reviewed: Not Peer Reviewed
• Public URL: https://uwe-repository.worktribe.com/output/868965
• Additional Information: Title of Conference or Conference Proceedings : International Association for the Study of Pain World Congress