The role of non-medical therapeutic approaches in the rehabilitation of Complex Regional Pain Syndrome

Purpose of the review: Non-medical therapeutic approaches are fundamental to the management of Complex Regional Pain Syndrome (CRPS) in order to promote the best outcome for patients. This review focuses on three key approaches underpinning CRPS rehabilitation, namely: physiotherapy and occupational therapy, psychological approaches and education and self-management. Recent Findings: Recently published European standards outline the quality of therapeutic care that people with CRPS must receive. Early initiated therapy is essential to optimise outcomes, underpinned by patient education. Therapists should promote early movement of the affected limb and encourage re-engagement with usual activities as immobilisation is known to have negative outcomes. There is evidence to support the possible long-term benefit of graded motor imagery and mirror therapy. Psychological assessment should include identification of depression and post-traumatic stress disorder, as treatment of these conditions may improve the trajectory of CRPS. Novel therapies include neurocognitive approaches and those addressing spatial bias, both of which should provide a focus for future research.Summary: There exists a broad range of non-medical therapeutic approaches to rehabilitation for CPRS that are thought to be important. However, the evidence for their efficacy is limited. Further research using standardised outcomes would be helpful in developing targeted therapies for the future

Living with complex regional pain syndrome: Understanding the battle

Johnston-Devin, CM ORCiD: 0000-0003-2632-5383Living with complex regional pain syndrome (CRPS) can be described as similar to living with any other chronic pain condition, but with extra complications. Many health professionals have never heard of the condition and it is even less known in the general community. There is a diversity of presentations, no objective medical test for diagnosis, and it remains a diagnosis of exclusion based on clinical signs and symptoms. The pathophysiology is not fully understood and there is no dedicated treatment. There are only low-quality data supporting any treatment approach. Although there is no known cure it may go into remission. It may also reappear. The condition may occur spontaneously. Although the mechanisms are not well understood, it can spread to other parts of the body. This chapter is based on a PhD study entitled "Battling Complex Regional Pain Syndrome: A Phenomenological Study." The aim is to describe and discuss the meaning of living with CRPS. Using a heuristic hermeneutic phenomenological approach to investigate the phenomenon of living with CRPS, 17 patients and four health professionals from 6 different countries were interviewed. Textual material from internet blogs and a book containing patient stories were also included as data sources. As the first author has been diagnosed with the condition, she was interviewed as well. Serving multiple purposes, the interview transcript was used as data while allowing for explication of preunderstandings and assumptions. This is an important step in phenomenological research. Findings revealed that living with CRPS is a daily battle. Within the battle analogy, readers can recognise aspects of the themes and relate to them on some level. Within this battle, there are many smaller, but important, fights