Body Perception Disturbance and Pain Reduction in Longstanding Complex Regional Pain Syndrome Following a Multidisciplinary Rehabilitation Program

Abstract

Objective Clinical guidelines for the treatment of complex regional pain syndrome recommend multidisciplinary rehabilitation, yet limited evidence exists to support the effectiveness of this approach. Body perception disturbance, a common and debilitating feature of complex regional pain syndrome, is recommended by guidelines as important to treat. However, no study has yet explored whether disturbances change in response to multidisciplinary rehabilitation. We aimed to determine whether there is a change in body perception disturbance and pain following a two-week multidisciplinary rehabilitation program for complex regional pain syndrome. Methods Retrospective clinical data from complex regional pain syndrome patients who completed the program between September 2014 and December 2016 were extracted and anonymized. Data collected pre- and post rehabilitation comprising the Bath Body Perception Disturbance scale and a pain intensity numerical rating scale were analyzed. Results Thirty complete data sets were analyzed from a sample of 50 consecutive patient records. After the program, there was a significant reduction in body perception disturbance (P < 0.0001), strength of negative emotional feelings (P < 0.0001), and pain (P = 0.0038). There was a significant correlation between a change in disturbance and pain (r = 0.44, P = 0.024). No relationship was found between the duration of symptoms and changes in disturbance (r = 0.04, P = 0.82). Conclusions This study provides evidence that both body perception disturbance and pain reduce after rehabilitation. Findings suggest that targeting these disturbances may be important in reducing pain and may be a potentially useful measure for recovery. Controlled trials are required to confirm the effectiveness of rehabilitation and determine what factors are responsible for these reductions.

Complex Regional Pain Syndrome: A Comprehensive Review

“…As symptoms of CRPS exhibit a variable progression over time, early initiation of therapy is integral to patient prognosis, with the goals of restoring limb functionality, decreasing pain, and improving quality of life [ 52 , 53 ]. This often requires a multidisciplinary approach involving patient education, physical and occupational therapy, psychiatry, and pain medicine specialists, along with pharmacological and surgical interventions.…”

Explicit and Implicit Own's Body and Space Perception in Painful Musculoskeletal Disorders and Rheumatic Diseases: A Systematic Scoping Review

“…Although they must be considered within the limits of their low evidence value, case studies and preliminary investigations showed promising results of dedicated interventions (Stanton et al, 2018;Nishigami et al, 2019) addressing specific kind of SoP disorders at the baseline, as found in CRPS (Lewis et al, 2019).…”

“…Considering the complexity of the body experience phenomenon, future studies should consider the concomitant assessment of different domains of bodily experience (explicit and implicit SoP, BO, and SpP), in parallel to the clinical variables commonly used for clinical studies, as some authors have started to do with CRPS patients (Lewis et al, 2019). Intervention studies should determine the response of particular sub-groups of patients, for e.g., those with enlarged or diminished body perception Moreira et al, 2017;Adamczyk et al, 2018a), to dedicated perceptual training interventions (Lewis et al, 2019). Moreover, the preliminary detection of perceptual impairments and the potential identification of particular sub-groups in clinical studies may help to identify individuals who could potentially benefit from dedicated treatments, or sub-groups that may be resistant to usual cares.…”

“It's Not My Knee”: Understanding Ongoing Pain and Discomfort After Total Knee Replacement Through Re‐Embodiment

“…In terms of optimizing postoperative outcomes, our study suggests that the interest for rehabilitation becomes not only strengthening the joint and promoting full recovery to tasks, but also modifying a person's relationship with the new joint to achieve full incorporation or re-embodiment. Multidisciplinary rehabilitation programs for other conditions, including CRPS, include a range of strategies to increase re-embodiment and improve body perception disturbances (38). Enhanced or virtual reality interventions show promise in improving body perceptions, function, and proprioception in musculoskeletal conditions, including knee replacement (39)(40)(41).…”