Background & Aims

Complex regional pain syndrome (CRPS) is a severe complication of tissue injury of the extremities. The biggest improvements are assumed to take place during the first months. While the early diagnosis is deemed crucial for therapy success, in reality, there are multiple barriers hindering the rapid recognition of this devastating condition [1]. In January 2020, a new CRPS pathway was implemented in the University Hospi-tal of Bern to increase awareness and improve early diagnosis and referral to the out-patient pain clinic. Specifically, further training was offered once a year and a simple assessment sheet was integrated into the clinical process in accordance with the rec-ommendations of the Valencia consensus.

Methods

Registry analysis of patients with CRPS before and after the pathway in January 2020. The data was extracted systematically from medical records of all patients seen in the Department of Anesthesiology and Pain Medicine by the data science center, based on a pre-defined codebook: Sex, age, type of injury, type of CRPS, extremity affected, additional diagnoses, drug history, dates of: injury, surgery (if available), referall, visit in the outpatient pain clinic and (first) diagnosis. Furthermore, the date of the first re-ported signs and symptoms was extracted if available. Missing data from the extrac-tion was added manually from medical reports. Unclear or ambiguous cases were checked manually by two study authors (PK and MH). Patients were then split into cases with referral before and after implementation of the new pathway to assess whether it led to a change in referral time. Further time intervals were calculated where available.

Results

Between January 2010 and September 2023, 197 patients with suspected CRPS and referral to the outpatient pain clinic were recruited and showed typical characteristics of a CRPS cohort (median age 47 years, 64% female, 82% CRPS type I, 53% upper extremity affected). Comparison between referral times before and after introduction of the CRPS pathway resulted in a drop from a median of 602 (interquartile range 196-959) days to 180 (99-511; P<.001) days. Trigger types and affected extremities did not differ significantly between both groups.

Conclusions

The implementation of the new CRPS pathway demonstrated a significant reduction in referral times of over 70% for patients with suspected CRPS, highlighting the efficacy of the intervention. The observed drop in referral time is of high importance, aligning with the overarching goal of improving early diagnosis and treatment of CRPS, as rec-ognized in the existing literature [2]. The findings underscore the practical significance of incorporating training sessions and integrating an assessment sheet into the clinical process, aligning with the Valencia consensus recommendations. The use of system-atically extracted registry data over a long period of time, lends robustness to the ob-served outcomes. Further research should delve into long-term patient outcomes and the sustained effectiveness of the intervention, which would provide a better under-standing of the pathway’s comprehensive impact on the trajectory of patients with CRPS.

References

[1] Harnik MA, Kesselring P, Ott A, Urman RD, Luedi MM. Complex Regional Pain Syndrome (CRPS) and the Value of Early Detection. Curr Pain Headache Rep 2023. doi:10.1007/s11916-023-01124-3.
[2]Lunden LK, Jorum E. The challenge of recognizing severe pain and autonomic abnormalities for early diagnosis of CRPS. Scand J Pain. 2021;21:548–59. doi: 10.1515/sjpain-2021-0036

Presenting Author

Michael Alexander Harnik

Poster Authors

Michael Alexander Harnik

Dr. med.

University Hospital Inselspital Bern

Lead Author

Florian Reisig

Dr. med.

Inselspital, Bern University Hospital, Switzerland

Lead Author

Pascal Kesselring

med. pract.

Inselspital, Bern University Hospital, Switzerland

Lead Author

Helen Anwander

PD Dr. med.

Inselspital, Bern University Hospital, Switzerland

Lead Author

Nina Bischoff

Dr. med.

Inselspital, Bern University Hospital, Switzerland

Lead Author

Esther Vögelin

Prof. Dr. med.

Inselspital, Bern University Hospital, Switzerland

Lead Author

Konrad Streitberger

Inselspital, Bern University Hospital, Switzerland

Lead Author

Topics

  • Access to Care