Factors associated with disability and pain intensity in patients with complex regional pain syndrome

Farzad, Maryam; MacDermid, Joy C.; Packham, Tara; Khodabandeh, Behzad; Vahedi, Mohsen; Shafiee, Erfan

doi:10.1080/09638288.2021.2009045

Cited by 16 publications

(17 citation statements)

References 66 publications

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“…This association may contribute to developing psychological symptoms, like depressive symptoms, fear of movement, or anxiety, potentially driving an ongoing cycle of pain, fear of movement due to pain, functional limitations, and psychological symptoms. [78][79][80][81] This is where an integrated interdisciplinary and multimodal treatment approaches including PT, OT, and psychological intervention that is individually tailored becomes important. However, the role of psychological factors in the development and progression of CRPS is still uncertain.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome

Shafiee¹,

MacDermid

Packham

et al. 2023

The Clinical Journal of Pain

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Objectives: To summarize and critically appraise the body of evidence on conservative management of complex regional pain syndrome (CRPS), we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: We conducted a literature search from inception to November 2021 in the following databases: Embase, Medline, CINAHL, Google Scholar, PEDRO, and Psychinfo. Two independent reviewers conducted risk of bias and quality assessment. Qualitative synthesis and meta-analysis were the methods for summarizing the findings of the RCTs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the overall quality and certainty of the evidence on each treatment outcome. Result: Through a database search, 751 records were found, and 33 RCTs were eligible for inclusion. Studies were published between 1995 and 2021. The overall risk of bias for 2 studies was low, 8 studies were unclear, and 23 studies were high. Low-quality evidence suggests that mirror therapy (as an addition to conventional stroke rehabilitation interventions) and graded motor imagery program (compared with routine rehabilitation interventions) may result in a large improvement in pain and disability up to 6-month follow-up in poststroke CRPS-1 patients. Low-quality evidence suggests that pain exposure therapy and aerobic exercises as an additive treatment to physical therapy interventions may result in a large improvement in pain up to a 6-month follow-up. The evidence is very uncertain about the effect of all other targeted interventions over conventional physical therapy or sham treatments on pain and disability. Discussion: There is an ongoing need for high-quality studies to inform conservative management choices in CRPS.

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Section: Discussionmentioning

confidence: 99%

The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome

Shafiee¹,

MacDermid

Packham

et al. 2023

The Clinical Journal of Pain

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“…However, it was not significant for other outcomes (disability, pain) nor in other studies. In the literature, the influence of gender on prognosis is contradictory (Farzad et al, 2021; van Velzen et al, 2019; Wertli et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…For example, depressive scores were associated with pain intensity (Kindl et al, 2022; Park et al, 2020). Pain catastrophizing score was correlated with a disability, pain at rest and pain with movement (Farzad et al, 2021). In contrast, in a two‐round Delphi survey (Brunner et al, 2011), 39 experts associated a worse prognosis in CRPS with some clinical manifestations ( pain intensity >5 on visual analogue scale [VAS] , allodynia , hypoesthesia , joint contracture , …).…”

Section: Discussionmentioning

confidence: 99%

Biological and psychological early prognostic factors in complex regional pain syndrome: A systematic review

Louis

Meyer

Legrain

et al. 2022

European Journal of Pain

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Background and objective Several risk factors for the onset of CRPS have been found, but evidence for prognostic factors associated with the progression of this condition remains sparse. However, the detection and management of these factors are necessary to design secondary prevention strategies. The objective of this systematic review was to identify prognostic factors in adult individuals with early CRPS. Database and data treatment PubMed, Embase, PsycINFO, Cochrane Library and Scopus, were published between January 1990 and November 2021. Two independent investigators selected cross‐sectional and longitudinal studies looking at early (<12 weeks from onset) prognostic factors for pain, CRPS severity score, disability, return to work, or quality of life. The quality in prognostic studies (QUIPS) tool was used to assess the risk of bias. A qualitative meta‐synthesis was performed. Results Out of 4652 different articles, six studies met the inclusion criteria. We identified 21 early factors associated with a poorer prognosis in type I CRPS. We found moderate evidence to support six of them: higher pain intensity, self‐rated disability, anxiety, pain‐related fear, being a female and high‐energy triggering event. Only two studies had an overall low risk of bias. Conclusions This study showed an important lack of information on early prognostic factors in CRPS. Only one article investigated the link with psychological characteristics. There is a crucial need for larger studies, with a well‐defined population using validated measures. Significance This systematic review highlights the lack of knowledge about early prognostic factors in CRPS. A few putative prognostic factors were identified. Most of the moderate evidence is related to a single cohort. Future research is required to find out which patients are vulnerable to chronification.

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“…Although a specific “cut point” in the PCS scoring system to identify those at risk was not provided, a different study was able to identify a PCS score of 22 as the one that best distinguished between patients with and without mental health comorbidity 4 . A second study found that a PCS score of ≥18.5 was associated with higher risk of experiencing pain and disability 5 . A third study noted that a PCS score of ≥23 was classified as “high-catastrophizing.” 6 These cut-off points will help the treating physician to determine a high-risk individual.…”

Section: Commentarymentioning

confidence: 95%

Clinical Practice Insights into Pain Management

Melhorn

2022

Journal of Bone and Joint Surgery

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Factors associated with disability and pain intensity in patients with complex regional pain syndrome

Cited by 16 publications

References 66 publications

The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome

The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome

Biological and psychological early prognostic factors in complex regional pain syndrome: A systematic review

Clinical Practice Insights into Pain Management

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