Oral Presentation NZ Association of Plastic Surgeons & NZ Society for Surgery of the Hand

Evidence for non-pharmacological treatment of upper limb Complex Regional Pain Syndrome: An integrative review (1503)

Grace S. Griffiths 1 , Jennifer Dunn 1 , Bronwyn Lennox Thompson 1 , Deborah L. Snell 1
  1. Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, 8011, New Zealand

Background: Complex Regional Pain Syndrome (CRPS) most frequently affects the upper limb, with high associated disability. It is challenging to diagnose and treat, and no management pathway exists for the New Zealand context. While non-pharmacological approaches are recommended as the first line of treatment, no evidence synthesis has appraised treatment specific to the upper limb.

Methods: Using an integrative review methodology, 13 databases were searched to identify published studies on non-pharmacological management of upper limb CRPS. The Crowe Critical Appraisal Tool guided quality ratings for included studies, and analysis employed a qualitative descriptive approach.

Results: From 236 abstracts reviewed, 113 full texts were read, and 38 articles selected for inclusion. Designs included single case (n=14), randomised control (n=8), prospective cohort (n=8), case series (n=4), retrospective (n=3), and mixed methods (n=1). Interventions were classified as sensory retraining (n=13), kinesiotherapy (n=7), manual therapies (n=7), physical modalities (n=6), and interdisciplinary programmes (n=5). All studies measured pain intensity, and most (n=24) measured objective physical parameters including strength, movement, or perceptual abilities. Few measured patient-rated function (n=13), perception of change (n=2) or psychological factors (n=4). Quality ratings ranged from 30% to 93%, with a median of 60%.

Discussion: The methodological quality of studies of upper limb CRPS treatment is overall poor. These results confirm that movement, desensitisation, and graded functional activity remain the mainstays of non-pharmacological intervention. Despite the impact of CRPS on wellbeing and function, psychological factors and patient-rated functional outcomes are infrequently addressed.

Conclusions: As optimal CRPS management remains an enigma, highlighting the priorities of service users themselves to guide future CRPS management is recommended. This review is the first part of a mixed methods study exploring peoples’ experiences of diagnosis and treatment for upper limb CRPS in New Zealand, in order to provide recommendations for a management pathway informed by lived experiences.