Complex Regional Pain Syndrome: A new model of care improving patient outcomes

BACKGROUND:
Complex regional pain syndrome (CRPS) is a painful and functionally debilitating condition associated with both sensory and motor abnormalities and consistently challenges hand therapists. Clinical opinion and current literature states that early recognition of CRPS can improve outcomes. However, early recognition remains poorly defined. Rehabilitation improves function and reduces pain, yet the type of rehabilitation remains uncertain. Current evidence supports graded motor imagery (GMI), however the sensory disturbances are also functionally debilitating and must also be overcome.

PROBLEM:
i. In the acute hospital setting, there is poor identification of early CRPS
ii. Effective clinical intervention is poorly defined

INTERVENTION:
• Developed and implemented a sensori-motor program based on the accepted GMI concepts
• Consolidated strong relationship with pain services
• Developed clinical algorithm, identification tool and early referral pathway to assist clinicians in the emergency department (ED) and key medical units to identify patients
• Initial and regular education to ED staff and relevant surgical teams

EVALUATION:
Preliminary evaluation indicates patients presenting within Melbourne Health with signs and symptoms of upper limb CRPS are being identified earlier and referred for specific CRPS assessment and intervention. Furthermore, since introducing the sensori-motor program, patient outcomes have been further improved, including a higher percentage returning to work.

RECOMMENDATIONS:
A streamlined pathway for this cohort enables early specialised intervention and an opportunity to greatly influence the outcomes. Clinical decision making tools and education provide resources to primary contact clinicians. Ongoing evaluation of the effectiveness of this sensori-motor program is required.