Denying the Truth Does Not Change the Facts: A Systematic Analysis of Pseudoscientific Denial of Complex Regional Pain Syndrome

Abstract

Several articles have claimed that complex regional pain syndrome (CRPS) does not exist. Although a minority view, it is important to understand the arguments presented in these articles. We conducted a systematic literature search to evaluate the methodological quality of articles that claim CRPS does not exist. We then examined and refuted the arguments supporting this claim using up-to-date scientific literature on CRPS. Methods: A systematic search was conducted in MEDLINE, EMBASE and Cochrane CENTRAL databases. Inclusion criteria for articles were (a) a claim made that CRPS does not exist or that CRPS is not a distinct diagnostic entity and (b) support of these claims with subsequent argument(s). The methodological quality of articles was assessed if possible. Results: Nine articles were included for analysis: 4 narrative reviews, 2 personal views, 1 letter, 1 editorial and 1 case report. Seven points of controversy were used in these articles to argue that CRPS does not exist: 1) disagreement with the label "CRPS"; 2) the "unclear" pathophysiology; 3) the validity of the diagnostic criteria; 4) CRPS as a normal consequence of immobilization; 5) the role of psychological factors; 6) other identifiable causes for CRPS symptoms; and 7) the methodological quality of CRPS research. Conclusion:The level of evidence for the claim that CRPS does not exist is very weak. Published accounts concluding that CRPS does not exist, in the absence of primary evidence to underpin them, can harm patients by encouraging dismissal of patients' signs and symptoms.

What do I need to know? Essential educational concepts for complex regional pain syndrome

“…The themes with the highest consensus for people with CRPS were General Advice and Mindset which focussed on the individual journey and inspiring hope, and Self‐management and Advocacy which focussed on encouraging people with CRPS to research and understand the condition to ‘become your own advocate’. These concepts may reflect that CRPS is generally not well understood by HCPs (Grieve et al, 2016; Rodham et al, 2016; Rodham, Boxell, et al, 2012)—even to the point of denial of the disorder in some cases—(Bharwani et al, 2021), which often leads to uncertainty about the diagnosis and a lack of sufficient information to understand or manage the disorder (Moore et al, 2021). Future efforts made by HCPs to incorporate more messages of hope and support to those living with CRPS seem relevant based on CRPS group ratings, particularly in the early stages of diagnosis and management.…”

Harmful or safe? Exposure and pain provocation during physiotherapy of complex regional pain syndrome I: a narrative review

“…Further, although the pain is often described with 9 characteristics typical of neuropathic pain, peripheral 10 nerve lesions have typically not been proven in type I 11 CRPS [1][2][3][4]. CRPS is a clinical diagnosis with a controversial history that covers a relatively heterogeneous group of clinical manifestations with not fully explained etiopathogenesis [5,6]. CRPS is now predominately being associated with functional and structural changes in the neurological and immune systems, however, the results of different authors are often contradictory [7][8][9][10][11][12][13][14][15][16][17][18].…”