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Review
. 2021 Oct 27:14:3359-3376.
doi: 10.2147/JPR.S326638. eCollection 2021.

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

K D Bharwani #  1 , A B Kersten #  1 , A L Stone  2 , F Birklein  3 , S Bruehl  2 , M Dirckx  1 , P D Drummond  4 , J Gierthmühlen  5 , A Goebel  6 , L Knudsen  7 , F J P M Huygen  1
Affiliations
Review

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

K D Bharwani et al. J Pain Res. .

Abstract

Purpose: 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: chronic pain; complex regional pain syndrome; pathophysiology; treatment.

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Conflict of interest statement

Dr Amanda Stone reports grants from IASP, grants from NIH, outside the submitted work. Dr S Bruehl reports personal fees from NeuroBo, outside the submitted work. Prof. Dr. Janne Gierthmühlen report Travel support from Novartis, Pfizer, Grünenthal, personal fees from Lilly GmbH, TAD Pharma, personal fees from Certkom, outside the submitted work. Dr A Goebel report production of medico-legal reports for the Court. Prof. Dr. FJPM Huygen report personal fees from ABBOTT, grants, personal fees from Saluda, personal fees from Boston Scientific, personal fees from Grunenthal, personal fees from Pfizer, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram of article selection.
See this image and copyright information in PMC

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