Complex Regional Pain Syndrome, Hand Fractures, Peripheral Nerve Injuries
Conditions
Keywords
allodynia, complex regional pain syndrome, peripheral nerve injuries, clinical measurement properties
Brief summary
This pilot study will test a new therapy, somatosensory rehabilitation, for the painful sensitivity experienced by persons with nerve injuries and/or complex regional pain syndrome (CRPS). Several methods for measuring pain and sensitivity that emphasize the person's evaluation of their own symptoms and the impact of these symptoms on their daily activities will also be tested to make sure they are consistent and accurate. Previous research has suggested one of the assessments may also be used to assist in the identification of CRPS: this simple test will be evaluated to see if it can accurately identify persons with this disorder (for which there is currently no diagnostic test). Together, this will improve treatment of CRPS through early, accurate diagnosis and the ability to measure important changes in this painful condition, and set up future studies for this new rehabilitation treatment method.
Detailed description
We will test four groups: persons with CRPS of one upper extremity, persons with recent hand fractures (\<12 weeks) or peripheral nerve injuries with residual sensory deficits at the time of the study, and healthy normal volunteers with a battery of assessments for CRPS, including a technique to precisely localize and quantify static mechanical allodynia.
Interventions
OTHERSomatosensory rehabilitation
OTHERUsual treatment: physiotherapy
Sponsors
Canadian Institutes of Health Research (CIHR)
Hamilton Health Sciences Corporation
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
16 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Diagnosis of a) Complex Regional Pain Syndrome or b) Peripheral Nerve Injury or c) recent hand trauma without peripheral nerve injury in a single upper extremity confirmed by physician or medical record. * Participant and most responsible physician give consent to exclusive focus on somatosensory rehabilitation for the duration of the trial (6 months). The participant may continue any oral medications but any planned use of topical medication, injections or IV medication in the affected limb is contra-indicated. Use of these modalities in an emergency situation would of course take priority.
Exclusion criteria
* History of cardiac or vascular disease or known sensitivity to sympathetic stress or cold intolerance or medically unstable * Confounding diagnoses: whiplash, nerve root compression, metabolic diseases such as diabetes or thyroid problems, and/or peripheral neuropathy * Open wounds on testing sites * Unable to provide informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| McGill Pain Questionnaire | baseline to 6 month follow-up | total number and intensity of sensory and affective pain descriptors selected by participant |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain subscale of the Patient-Rated Wrist and Hand Evaluation | Baseline to six months | 5 questions rating self-reported pain at rest, with movement, pain with lifting, worst pain and pain frequency. |
| Hamilton Inventory for Complex Regional Pain Syndrome | Baseline to 6 months | Includes a both a patient-reported scale addressing symptoms, daily function and psychosocial concerns; and a clinician-based assessment of clinical signs |
| Radboud Evaluation of Sensitivity- English version | Baseline to 6 months | self-reported evaluation of sensitivity in an area of injury/trauma |
Other
| Measure | Time frame | Description |
|---|---|---|
| Goniometric measurement of active range of motion (ROM) of the upper extremities | Baseline to 3 months | Measures of affected and unaffected limbs (shoulder flexion and abduction, elbow flexion/extension, wrist flexion/extension, forearm pronation/supination, active functional ROM of the fingers, thumb opposition). |
| Pain Catastrophizing Scale | Baseline to 6 months | Measures pain-related beliefs |
| Dynamometry for grip and pinch strength | Baseline to 3 months | bilateral measures of hand grip and pinch strength |
| Allodynography | Baseline to 3 months | a graphical technique to anatomically map allodynia associated with a specific nerve branch and assess the area and associated pressure threshold |
| 10 test | Baseline to 3 months | quick form of quantitative sensory testing for light touch sensation and hypersensitivity |
| Infra-red skin temperature measurement asymmetry | Baseline and 3 months | Infra-red measures of skin temperature are taken over 3 specific areas (corresponding to the most distal autonomous innervation from the 3 major peripheral nerves of the upper limb) and symmetry is compared between the right and left arms. This measurement procedure is then repeated after a 30 second immersion of the right foot in ice water (5 degrees C). |
Countries
Canada
Outcome results
None listed