Therapy Treatment for CRPS Within a Clinical Setting

Complex regional pain syndrome (CRPS) is a painful and debilitating disorder that usually occurs after limb injury, but can also occur without injury. Typical symptoms specific to the affected limb include; painful changes in skin sensitivity, marked swelling, vivid colour changes, pronounced temperature changes, problems with initiation and control of movement and feelings of disconnection with the affected limb. Persons with CRPS commonly suffer significant levels of disability, loss of function and distress. This in turn can severely compromise a person's quality of life. Guidelines support physiotherapy and occupational therapy treatment for the management of CRPS [3]. It is however not clear from current research as to which particular therapy interventions are most effective. Additionally, the effectiveness of different clinical approaches is poorly reported.

Evidence has emerged to support the use of therapy techniques such as graded motor imagery (GMI) as a treatment approach. GMI involves a three stepped approach to retrain the cortex in respect to aspects of motor control. We have published evidence that demonstrated within clinical practice, this treatment approach alone was not effective in terms reducing pain intensity. Since this publication we have continued to integrate aspects of GMI but moved away from using it as a standalone treatment within therapy outpatient clinics.

Within current therapy sessions the overarching treatment principle is to improve sensory and motor processing in order to promote better movement and function. Initial assessment of patients helps therapists to identify relevant treatment approaches that may influence different aspects of the nervous system in respect to this. For example some patients may present with very heightened and painful skin sensations and therefore desensitising techniques that target peripheral nervous system drivers may be of particular relevance. Whereas patients who present with problems recognising their limb or who struggle to initiate active limb movement may benefit from treatment approaches that target retraining the brain in respect to aspects of motor processing. All patients additionally received education regarding pain mechanisms, flare up management and grading and pacing of activities affected by the condition.

The study aims to establish whether the current therapy treatment within the described clinical setting is effective in improving function and activity for people with long-standing complex regional pain syndrome.

Further aims are to:

• Describe typical therapy treatment delivered within the CRPS therapy clinics for patients with longstanding CRPS.
• Evaluate impact of treatment in terms of neglect like symptoms, pain and quality of life.
• Evaluate presenting baseline symptom profiles to help determine what predictors respond and influence response to therapy.
• To compare changes in outcomes from this patient group with 20 historical patients treated with GMI therapy alone to evaluate potential differences in treatment responses.

This study will analyse already collected data sets and also review patient case notes to obtain further information in respect to therapy treatment, patient demographics and symptom profiles.