Complex Regional Pain Syndrome: Current Practice Management and Referral Trends in a Closed Healthcare System

Q4 Medicine Clinical Osteology Pub Date : 2020-12-31 DOI:10.3390/osteology1010004
C. Zale, Joshua Hansen, P. Ryan
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Abstract

Background: Complex regional pain syndrome (CRPS) is a neurologic condition that can present with severe pain and dysfunction. Delay in treatment adversely affects outcomes. The purpose of this study is to evaluate patient outcomes as they relate to the time from diagnosis to pain management referral once the diagnosis of CRPS has been made in a closed healthcare system. Methods: A retrospective record review from a closed healthcare system was utilized for CRPS cases from 2010–2019. Demographics, injury pattern, surgeries, pain score, treatment modalities, occupational outcomes, and time to pain management referral were recorded. Results: There were 26 cases of CRPS that met inclusion criteria. The mean time from diagnosis to treatment was 55 days. 16/26 (61.5%) were medically discharged from the military. 23/26 (88.5%) were unable to return to full duty due to CRPS. There was no significant difference in the reported pain scores over time regardless of treatment (p = 0.76). A linear regression demonstrated a significantly higher Visual Analog Scale Pain Score (VAS) over time in patients that were medically discharged (p = 0.022). Conclusions: The mean delay in referral to the pain service was 55 days. The majority of patients (88.5%) did not return to full duty secondary to the diagnosis of CRPS, and 61.5% of patients required medical separation from active duty. Due to the negative impact that the diagnosis of CRPS has on occupational outcomes with a mean delay in referral of 55 days, clinics and providers should set up referral criteria and establish early pain pathways for patients diagnosed with CRPS.
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复杂的区域性疼痛综合征:目前的实践管理和转诊趋势在一个封闭的医疗保健系统
背景:复杂区域疼痛综合征(CRPS)是一种神经系统疾病,可表现为严重的疼痛和功能障碍。治疗延误会对结果产生不利影响。本研究的目的是评估患者的结果,因为一旦在封闭的医疗保健系统中诊断出CRPS,他们就会从诊断到疼痛管理转诊的时间。方法:对2010-2019年封闭医疗系统的CRPS病例进行回顾性记录回顾。记录人口统计、损伤类型、手术、疼痛评分、治疗方式、职业结局和疼痛管理转诊时间。结果:26例CRPS符合纳入标准。从诊断到治疗的平均时间为55天。16/26(61.5%)因病退伍。23/26(88.5%)由于CRPS无法返回全职工作。无论治疗方式如何,报告的疼痛评分随时间变化无显著差异(p = 0.76)。线性回归显示,随着时间的推移,医学出院患者的视觉模拟量表疼痛评分(VAS)显著提高(p = 0.022)。结论:转介到疼痛服务的平均延迟为55天。大多数患者(88.5%)在诊断为CRPS后没有重返工作岗位,61.5%的患者需要医学分离。由于CRPS诊断对职业结局的负面影响,平均延迟转诊55天,诊所和提供者应该为诊断为CRPS的患者建立转诊标准和早期疼痛通路。
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Clinical Osteology
Clinical Osteology Medicine-Endocrinology, Diabetes and Metabolism
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