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How should we treat painful sensitivity in the hand? An international e-Delphi study
Andrea Hebert1, Joy MacDermid2, Jocelyn Harris1
1School of Rehabilitation Sciences, McMaster University, Institute for Applied Health Sciences, Hamilton, Ontario, Canada.
Summary
Hand therapists recommend tailored programs for neuropathic pain allodynia. Consensus was reached on diverse physical, sensory, and cognitive strategies, but not on all justifications or implementations.
Area of Science:
- Pain Management
- Neurology
- Rehabilitation Therapy
Background:
- Neuropathic pain allodynia has limited effective interventions.
- Hand therapy practice shows conflicting approaches to managing allodynia.
- Expert consensus is needed to guide clinical practice.
Framework:
- An international e-Delphi survey was conducted.
- Hand rehabilitation experts from 19 countries participated.
- Consensus required 75% agreement over at least 3 rounds.
Implementation:
- Over 900 treatment suggestions were gathered.
- 46 clinical practice recommendations reached consensus.
- Discrepancies noted in justifying and implementing techniques like desensitization.
Implications:
- Individually tailored programs using physical, sensory, and cognitive approaches are recommended.
- Recommendations align with the Neuromatrix Model of Pain.
- Further research and trials are needed due to lack of consensus on some methods and limited evidence.
