Somatosensory rehabilitation for allodynia in complex regional pain syndrome of the upper limb: A retrospective cohort study.
METHODS
Retrospective cohort study.


BACKGROUND
Somatosensory rehabilitation is a standardized method of evaluation and conservative treatment of painful disorders of vibrotactile sensation, including the mechanical allodynia and burning pain of complex regional pain syndrome (CRPS).


OBJECTIVE
The purpose of this study was to examine the effectiveness of somatosensory rehabilitation for reducing allodynia in persons with CRPS of 1 upper limb in a retrospective consecutive cohort of patients.


METHODS
An independent chart review of all client records (May 2004-August 2015) in the Somatosensory Rehabilitation Centre (Fribourg, Switzerland) identified 48 persons meeting the Budapest criteria for CRPS of 1 limb who had undergone assessment and treatment. Outcomes of interest were the French version of the McGill Pain Questionnaire (Questionnaire de la Douleur St-Antoine [QDSA]), total area of allodynia as recorded by mapping the area of skin where a 15-g monofilament was perceived as painful, and the allodynia threshold (minimum pressure required to elicit pain within the allodynic territory).


RESULTS
This cohort was primarily women (70%), with a mean age of 45 years (range: 18-74). Mean duration of burning pain was 31 months (range: 1 week-27.5 years), and baseline QDSA core was 48. The average primary area of allodynia was 66 cm2(range: 2.6-320), and the most common allodynia threshold was 4.0 g. The average duration of treatment was 81 days. At cessation of treatment, the average QDSA score was 20 (effect size Cohen's d = 1.64). Allodynia completely resolved in 27 persons (56% of the total sample where only 58% completed treatment).


CONCLUSIONS
This uncontrolled retrospective study suggests that somatosensory rehabilitation may be an effective treatment with a large effect size for reducing the allodynia and painful sensations associated with CRPS of the upper limb. More work is in progress to provide estimates of reliability and validity for the measurement tools for allodynia employed by this method.


METHODS
2c.
School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; Hand Therapy Clinic, Hamilton Health Sciences, Hamilton, Ontario. Electronic address: packhamt@gmail.com.
Tara L
TL
Packham
Somatosensory Rehabilitation Centre, Fribourg, Switzerland; Department of Anatomy and Physiology, University of Fribourg, Fribourg, Switzerland.
Claude J
CJ
Spicher
School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; School of Physiotherapy, Western University, London, Ontario, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada.
Joy C
JC
MacDermid
School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada.
Susan
S
Michlovitz
Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
D Norman
DN
Buckley
D000293:Adolescent; D000328:Adult; D000368:Aged; D020918:Complex Regional Pain Syndromes / Q000150:complications*; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D016896:Treatment Outcome; D034941:Upper Extremity; D055815:Young Adult
Allodynia; Complex regional pain syndrome; Monofilaments; Somatosensory rehabilitation