Complex Regional Pain Syndrome (CRPS): Survey of Current Practices

Background and Objectives: There are numerous treatments for complex regional pain syndrome (CRPS). These treatments are varied in scope and include pain management therapies, psychological therapies, and physiotherapy. Treatment guidelines have been published in the past, but little information exists as to how clinicians utilize these guidelines. Moreover, there has been a paradigm shift from the older “reflex sympathetic dystrophy” (RSD) nomenclature, with largely sympathetic block driven diagnosis and therapy to more recent trends towards more inclusive “CRPS” diagnostic criteria and multidisciplinary treatment. There remains controversy regarding the selection of various techniques, and the timing of advancement through the treatment algorithm to the more aggressive, interventional techniques. We set out to determine current CRPS treatment practices of interventional pain specialists. Methods: The authors developed a 36‐item, 15–20‐minute questionnaire. This questionnaire was sent to 453 interventional pain specialists. Results: One‐hundred‐five surveys were returned, with 100 being complete. Eighty‐three percent of our respondents were practicing anesthesiology pain specialists who on average treat 14.9 (SD = 16.8) CRPS patients per month. Conclusions: Our survey results revealed the use of a treatment algorithm for CRPS that consists of treatment using medical therapies (pharmacologic, blocks, catheters, and implantable devices), psychological therapies, and physiotherapy in a coordinated fashion. The trend among our survey respondents is to utilize increasingly interventional techniques after a failed 2‐ to 4‐week trial of any one particular therapy.     

Impact of the HEART Pathway on Admission Rates for Emergency Department Patients with Chest Pain: An External Clinical Validation Study

Background

Chest pain is a common emergency department (ED) chief complaint. Safe discharge mechanisms for low-risk chest pain patients would be useful.

Acceptance and Commitment Therapy for Chronic Pain: Evidence of Mediation and Clinically Significant Change Following an Abbreviated Interdisciplinary Program of Rehabilitation

There is an emerging body of evidence regarding interdisciplinary acceptance and commitment therapy in the rehabilitative treatment of chronic pain. This study evaluated the reliability and clinical significance of change following an open trial that was briefer than that examined in previous work. In addition, the possible mediating effect of psychological flexibility, which is theorized to underlie the acceptance and commitment therapy model, was examined. Participants included 117 completers of an interdisciplinary program of rehabilitation for chronic pain. Assessment took place at treatment onset and conclusion, and at a 3-month follow-up when 78 patients (66.7%) provided data. At the 3-month follow-up, 46.2% of patients achieved clinically significant change, and 58.9% achieved reliable change, in at least 1 key measure of functioning (depression, pain anxiety, and disability). Changes in measures of psychological flexibility significantly mediated changes in disability, depression, pain-related anxiety, number of medical visits, and the number of classes of prescribed analgesics. These results add to the growing body of evidence supporting interdisciplinary acceptance and commitment therapy for chronic pain, particularly with regard to the clinical significance of an abbreviated course of treatment. Further, improvements appear to be mediated by changes in the processes specified within the theoretical model.PerspectiveOutcomes of an abbreviated interdisciplinary treatment for chronic pain based on a particular theoretical model are presented. Analyses indicated that improvements at follow-up mediated change in the theorized treatment process. Clinically significant change was indicated in just under half of participants. These data may be helpful to clinicians and researchers interested in intervention approaches and mechanisms of change.     

Complex Regional Pain Syndrome in Children: a Multidisciplinary Approach and Invasive Techniques for the Management of Nonresponders

Complex regional pain syndrome (CRPS) is multifactorial condition with complex pathogenesis characterized by spontaneous or stimulus‐induced pain that is disproportionate to the inciting event. It is also commonly accompanied by a myriad of autonomic and motor disturbances in highly variable combinations. This condition has been underreported in children until recently. Consequently, the management of CRPS in the pediatric population presents an even greater challenge than in adults, partly because there is a lack of clinical data concerning the efficacy of the diverse treatment methods available, and partly because successful treatment of CRPS involves a multidisciplinary approach. In this retrospective case series, a multidisciplinary management plan is presented in 10 children for whom the standard noninvasive treatment was unsuccessful. Within this management plan, novel drugs were included such as the capsaicin 8% patch, in addition to invasive techniques in patients who did not respond to noninvasive therapies.     

Evidenced-Based Cognitive Rehabilitation for Persons With Multiple Sclerosis: An Updated Review of the Literature From 2007 to 2016

Objective

To update the clinical recommendations for cognitive rehabilitation of people with multiple sclerosis (MS), based on a systematic review of the literature from 2007 through 2016.