Patients’ experiences of treatment-relevant processes in multimodal pain rehabilitation for severe complex regional pain syndrome – a qualitative study

Abstract

Purpose

Complex regional pain syndrome (CRPS) is a longstanding condition with spontaneous and evoked pain, that usually occurs in an upper or lower extremity. Although it often resolves within the first year, it may for a minority progress to a chronic and occasionally severely disabling condition. The aim of this study was to explore patients’ experiences and perceived effects of a specific treatment, designed for patients with severe and highly disabling CRPS, in order to identify possible treatment-relevant processes.

Methods

The method used was a qualitative design, using semi-structured interviews with open-ended questions to capture participants’ experiences and perceptions. Ten interviews were analyzed using applied thematic analysis.

Results

Despite the fact that participants had a severe conditions, including nerve damage and a long duration of illness, they reported having been helped to increase flexible persistence, reduce fear and avoidance, and improve connections. This helped participants to significant improvements in daily life functioning.

Conclusions

The participants described distinct possible treatment-relevant processes leading to a substantial improvement in everyday life. The results imply that there is hope for this group that has been severely disabled for many years. This may help guide future clinical treatment trials.

IMPLICATIONS FOR REHABILITATION

• Flexible persistence, i.e., to lead a life more in line with personal values, despite pain and limitations, seems to be an important theme in the treatment for complex regional pain syndrome (CRPS).

• Acceptance-based exposure treatment can be helpful in reducing fear and avoidance behaviors.

• Both improved social connections and increased self-connection may be highly valuable in CRPS rehabilitation.

Keywords:

• CRPS
• rehabilitation
• processes
• qualitative
• exposure
• fear
• acceptance
• values

Author contributions

C Johannesson: Preparations, data collection, analyses, interpretation, writing and revising manuscript.

C Nehlin: Development of procedures, planning, preparations, training of assessors, analyses, interpretation, preparing and revising manuscript.

T Gordh: Planning, preparations, supervision, analyses, revising manuscript.

EB Hysing: Study design, planning, preparations, interpretation, drafting and revising manuscript.

K Bothelius: Project leader, study design, planning, preparations, interpretation, writing and revising manuscript.

Disclosure statement

None.

All authors discussed the results, contributed to and approved the final manuscript. Each author has participated sufficiently in the work to take public responsibility for its content.

Additional information

Funding

None.