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COMPLEX REGIONAL PAIN SYNDROME

PhD Thesis T. Packham, McMaster University

School of Rehabilitation Sciences

COMPLEX REGIONAL PAIN SYNDROME: ADVANCING REHABILITATION THROUGH BETTER EVALUATION AND TREATMENT

By TARA PACKHAM, BHSc(OT), MSc A Thesis Submitted to the School of Graduate Studies in Partial Fulfilment of the

Requirements for the Degree Doctor of Philosophy

McMaster University ? Copyright by Tara Packham, July 2016

PhD Thesis T. Packham, McMaster University

School of Rehabilitation Sciences

McMaster University DOCTOR OF PHILOSOPHY (2016) Hamilton, Ontario (Rehabilitation Sciences)

TITLE: Complex regional pain syndrome: advancing rehabilitation through better evaluation and treatment

AUTHOR: Tara Packham, BHSc(OT), MSc(RS) (McMaster University) SUPERVISOR: Dr. Joy C. MacDermid

NUMBER OF PAGES: xvi, 146

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PhD Thesis T. Packham, McMaster University

School of Rehabilitation Sciences

LAY ABSTRACT

Complex regional pain syndrome: advancing rehabilitation through better evaluation and treatment

Complex regional pain syndrome (CRPS) is a painful collection of symptoms that can develop after trauma. Why it happens is not well understood, but most scientists and health care providers agree that rehabilitation should be the primary focus for managing the painful consequences of this condition. There is a need for simple and accurate ways to assess CRPS, as well as to treat it. Better assessment will support treatment that is more targeted to the symptoms of the individual. One of the very challenging symptoms experienced by persons with CRPS is painful sensitivity of the skin, also known as allodynia. This thesis describes the development and testing of several new patientreported assessments for CRPS and allodynia, as well as two studies on a new method of treatment for allodynia.

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PhD Thesis T. Packham, McMaster University

School of Rehabilitation Sciences

Complex regional pain syndrome:

advancing rehabilitation through better evaluation and treatment

ABSTRACT

Introduction: Complex regional pain syndrome (CRPS) is a form of neuropathic pain that sometimes develops after trauma or surgery. While diagnostic criteria have been debated, there is agreement participation in rehabilitation should be the primary management. However, there are gaps in the evidence guiding assessment and treatment choices for individuals with CRPS. The purpose of this thesis was to advance the rehabilitation of CRPS by 1) ongoing development and refinement of evaluations for the specific symptoms of CRPS, and 2) to investigate effectiveness of a new treatment (somatosensory rehabilitation) posited to address allodynia associated with CRPS.

Methods: We conducted a series of 4 studies addressing various aspects of CRPS assessment and the somatosensory rehabilitation method: a) a cognitive debriefing study for content validation of the Patient-Reported Hamilton Inventory for CRPS; b) English translation and cultural validation of the Radboud Evaluation of Sensitivity; c) a retrospective cohort study of the effectiveness of somatosensory rehabilitation for allodynia in the upper limb; and d) a pilot study of the somatosensory rehabilitation method to consider the measurement properties of the embedded evaluation tools of allodynography and the rainbow pain scale, and to provide estimates for future controlled trials of effectiveness.

Results: The cognitive debriefing study identified potentially problematic items, and constructs which needed enhancement in future versions of the PR-HICRPS assessment. The second paper reported the translation and cultural validation of the RES-E, finding support for test-retest reliability, internal consistency, and preliminary evidence for construct validity and reproducibility. The third paper presented preliminary evidence of a strong effect size for the SRM in an uncontrolled consecutive cohort. Finally, the fourth paper provides an interm analysis of the psychometric properties of allodynography and the rainbow pain scale, and estimates large sample sizes will be required for future trials.

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