Background: Patients with complex regional pain syndrome (CRPS) are suffering from refractory chronic pain and reduced quality of life. Providing timely and proper multimodal rehabilitation program can alleviate the pain, improve the quality of life, and reduce the burden of medical expenses. This study aims to investigate factors affecting the effectiveness of inpatient rehabilitation in CRPS patients and to identify indications for inpatient rehabilitation.
Methods: Medical records were retrospectively reviewed from January 2017 to June 2020. Patients over 18 years of age who diagnosed as CRPS according to the Budapest criteria and received inpatient rehabilitation during the period were included. Multimodal rehabilitation program was provided for the patients. Primary outcome was the pain intensity at discharge minus admission by numeric rating scale (NRS). To analyze the effect of inpatient rehabilitation on pain improvement, following factors were analyzed: demographic, duration of disease, using intravenous opioid as a rescue medicine, having spinal cord stimulator, receiving scrambler treatment, CRPS severity score, CRPS type, region of CRPS, NRS score at admission and results of three phase bone scan(TBS), electromyography and thermography. Mann-Whitney test and simple linear regression test and multiple regression analysis were performed to identify variables associated with the pain improvement.
Results: Total 51 patients (19 male/32 female) were included. Patients without abnormalities in the TBS test had better pain relief than those with abnormalities in the TBS test (mean difference: 0.82; P=0.041). However, patients without abnormalities in the thermography test had worse outcome than those with abnormalities in the thermography test (mean difference: 1.89; P=0.032). Patients who had a pain intensity of 5 or higher at initial admission had better results of inpatient rehabilitation than those who had a pain intensity of less than 5 at admission (mean difference: 1.49; P=0.001). Simple linear regression test also revealed that the initial pain intensity significantly influences the effect of inpatient rehabilitation therapy, and the higher the initial pain intensity, the higher the effect of inpatient rehabilitation therapy (R2=0.263, β= -0.486; P<0.001). In the multiple regression analysis, only initial pain intensity showed statistically significant results (adjusted R2=0.256, β= -0.584; P=0.002).
Conclusions: Our results suggest that some clinical factors can affect the pain relief effect of inpatient rehabilitation. Severe initial pain intensity, abnormalities in the thermography test and no abnormalities in the TBS test showed better outcomes of inpatient rehabilitation. From these results, it may be possible to suggest the indications for inpatient rehabilitation therapy for patients with CRPS.
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