Journal of Pain Research (Oct 2021)

Denying the Truth Does Not Change the Facts: A Systematic Analysis of Pseudoscientific Denial of Complex Regional Pain Syndrome

  • Bharwani KD,
  • Kersten AB,
  • Stone AL,
  • Birklein F,
  • Bruehl S,
  • Dirckx M,
  • Drummond PD,
  • Gierthmühlen J,
  • Goebel A,
  • Knudsen L,
  • Huygen FJPM

Journal volume & issue
Vol. Volume 14
pp. 3359 – 3376

Abstract

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KD Bharwani,1,* AB Kersten,1,* AL Stone,2 F Birklein,3 S Bruehl,2 M Dirckx,1 PD Drummond,4 J Gierthmühlen,5 A Goebel,6 L Knudsen,7 FJPM Huygen1 1Center for Pain Medicine, Department of Anesthesiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; 2Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA; 3Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 4Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia; 5Division of Neurological Pain Research and Therapy, Department Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany; 6Director of the Pain Research Institute Reader in Pain Medicine, University of Liverpool Honorary Consultant in Pain Medicine, Walton Centre NHS Foundation Trust, Liverpool, UK; 7The National Rehabilitation Centre for Neuromuscular Diseases, Aarhus, Denmark*These authors contributed equally to this workCorrespondence: KD Bharwani Tel +31107040704Email [email protected]: Several articles have claimed that complex regional pain syndrome (CRPS) does not exist. Although a minority view, it is important to understand the arguments presented in these articles. We conducted a systematic literature search to evaluate the methodological quality of articles that claim CRPS does not exist. We then examined and refuted the arguments supporting this claim using up-to-date scientific literature on CRPS.Methods: A systematic search was conducted in MEDLINE, EMBASE and Cochrane CENTRAL databases. Inclusion criteria for articles were (a) a claim made that CRPS does not exist or that CRPS is not a distinct diagnostic entity and (b) support of these claims with subsequent argument(s). The methodological quality of articles was assessed if possible.Results: Nine articles were included for analysis: 4 narrative reviews, 2 personal views, 1 letter, 1 editorial and 1 case report. Seven points of controversy were used in these articles to argue that CRPS does not exist: 1) disagreement with the label “CRPS”; 2) the “unclear” pathophysiology; 3) the validity of the diagnostic criteria; 4) CRPS as a normal consequence of immobilization; 5) the role of psychological factors; 6) other identifiable causes for CRPS symptoms; and 7) the methodological quality of CRPS research.Conclusion: The level of evidence for the claim that CRPS does not exist is very weak. Published accounts concluding that CRPS does not exist, in the absence of primary evidence to underpin them, can harm patients by encouraging dismissal of patients’ signs and symptoms.Keywords: complex regional pain syndrome, pathophysiology, treatment, chronic pain

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