Improving health outcomes in complex regional pain syndrome to inform chronic pain practice

The research presented in this thesis focuses on improving health outcomes in the field of complex regional pain syndrome (CRPS) to inform chronic pain practice. Eight publications are presented, each accompanied by a critical commentary to evidence my contribution to the creation and interpretation of new knowledge in this field. The Researcher Development Framework (Vitae, 2010) provides a thread of connectivity against which my professional and personal development is mapped and evidenced. Several key research findings are presented in these publications. People with CRPS currently lack the information they need to self-manage their condition and healthcare professionals have difficulty diagnosing CRPS and using published diagnostic criteria. This may result in misdiagnosis and inappropriate management of CRPS, which may have long-term consequences for the patient in relation to receiving appropriate and targeted treatments. Future research should assess the impact of recently published CRPS European Standards in terms of uptake and impact on CRPS clinical practice. The research findings also reported a novel method of communicating and representing changes in body perception disturbance using digital media. This directly impacted CRPS clinical care as it allowed individuals to depict an alteration in body perception more accurately than relying on their verbal articulation of the changes. Future modifications should focus on developing technology for independent patient use which would mitigate the need for health professionals to administer the tool, promote patient self-management and provide scope for the technology to be used in a home-setting. Research found that the presence of pain lowers the threshold for the detection of sensorimotor disturbances, and this is strongly related to the intensity of pre-existing pain. It was found that the higher the level of pre-existing pain, the greater the report of sensory and motor disturbances. This confirms the benefit of routinely used clinical interventions that seek to improve sensorimotor congruence. Future research should investigate whether this mechanism contributes to the maintenance of pain in clinical populations. Three publications contributed to an ongoing, iterative programme of research which will inform the development of an international CRPS clinical research registry. The first questionnaire core outcome measurement set for CRPS clinical studies was agreed and recommendations were made for the collection of standardised CRPS outcome data. For the first time, an international CRPS registry will provide access to a large data set of CRPS-specific outcomes for interrogation. In the long-term, this has the potential to improve health outcomes for the CRPS population worldwide. It will enable researchers to better understand the potential phenotypes of CRPS and prognostic indicators, which in turn may impact clinical care through the development of more targeted therapeutic approaches. My academic and clinical competence as an independent nurse researcher and a research nurse leader is demonstrated though my achievement of the 12 RDF sub-domains (Vitae, 2010). The clinical impact of my research is described, and recommendations are made for future research and clinical practice.