Royal United Hospitals, Bath, UK.
University of the West of England, Bristol, UK.
Eur J Pain. 2018 Mar;22(3):551-564. doi: 10.1002/ejp.1138. Epub 2017 Dec 1.
Complex Regional Pain Syndrome (CRPS) symptoms can significantly differ between patients, fluctuate over time, disappear or persist. This leads to problems in defining recovery and in evaluating the efficacy of therapeutic interventions.
To define recovery from the patients' perspective and better understand their priorities for treatment approaches.
Establishing an international consortium, we used a 2-Round Delphi-based study in eight countries across Europe and North America. Participants ≥18 years who met, or had met, Budapest clinical criteria were included. Round 1 participants completed the statement: 'I would/do consider myself recovered from CRPS if/because…' alongside demographic and health questionnaires. Data were thematically organised and represented as 62 statements, from which participants identified and ranked their recovery priorities in Round 2.
Round 1 (N = 347, 80% female, 91% non-recovered) dominant ICF themes were: activities of daily living; bodily functions; external factors; participation and personal factors. The top five priority statements in Round 2 (N = 252) were: no longer having (1) CRPS-related pain, (2) generalised pain and discomfort, (3) restricted range of movement, (4) need for medication, (5) stiffness in the affected limb. With very few exceptions, priorities were consistent, irrespective of patient demographics/geography. Symptoms affecting daily activities were among those most frequently reported.
Our data showed a small number of themes are of highest importance to CRPS patients' definition of recovery. Patients want their pain, movement restriction and reliance on medication to be addressed, above all other factors. These factors should therefore be foremost concerns for future treatment and rehabilitation programmes.
Those with longstanding CRPS may no longer meet diagnostic criteria but still be symptomatic. Defining recovery is therefore problematic in CRPS. Our study has identified patients' definition of recovery from CRPS, in order of priority, as relief from: their CRPS-related pain, generalised pain, movement restriction, reliance on medication, and stiffness.
复杂区域疼痛综合征（CRPS）的症状在患者之间可能存在显著差异，且会随时间波动，可能消失或持续存在。这导致定义康复和评估治疗干预效果存在问题。
从患者的角度定义康复，并更好地理解他们对治疗方法的优先考虑。
通过建立一个国际联盟，我们在欧洲和北美八个国家进行了一项基于两轮德尔菲的研究。纳入年龄≥18 岁、符合或曾符合布达佩斯临床标准的患者。第一轮参与者填写了如下陈述：“如果/因为……，我会/已经认为自己从 CRPS 中康复了”，同时填写了人口统计学和健康问卷。数据通过主题组织，并以 62 个陈述的形式呈现，第二轮参与者从这些陈述中识别并对他们的康复优先级进行了排名。
第一轮（N=347，80%为女性，91%为未康复）中，国际功能、残疾和健康分类（ICF）的主导主题为：日常生活活动；身体功能；外部因素；参与和个人因素。第二轮（N=252）中排名前五的优先事项陈述为：（1）不再有 CRPS 相关疼痛，（2）全身性疼痛和不适，（3）运动范围受限，（4）需要药物治疗，（5）受累肢体僵硬。除了极少数例外，无论患者的人口统计学/地理位置如何，这些优先级都是一致的。影响日常活动的症状是最常报告的症状之一。
我们的数据表明，对 CRPS 患者康复定义最重要的主题很少。患者希望解决他们的疼痛、运动受限和对药物的依赖，而这是最重要的。因此，这些因素应该是未来治疗和康复计划的首要关注点。
患有长期 CRPS 的患者可能不再符合诊断标准，但仍有症状。因此，CRPS 的康复定义存在问题。我们的研究确定了患者对 CRPS 康复的定义，按优先级顺序依次为：缓解与 CRPS 相关的疼痛、全身性疼痛、运动受限、对药物的依赖和僵硬。
