Pain exposure physical therapy may be a safe and effective treatment for longstanding complex regional pain syndrome type 1: a case series

• Published in: Clinical rehabilitation 2009-12, Vol.23 (12), p.1059-1066
• Main Authors: Ek, Jan-Willem, van Gijn, Jan C, Samwel, Han, van Egmond, Jan, Klomp, Frank PAJ, van Dongen, Robert TM
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Analgesics; Anesthesiology; Chronic pain; Exercise Therapy; Feasibility Studies; Humans; Limbs; Middle Aged; Nervous system; Pain; Pain Measurement; Physical therapy; Physiotherapy; Prospective Studies; Recovery; Recovery of Function; Reflex Sympathetic Dystrophy - physiopathology; Reflex Sympathetic Dystrophy - therapy; Rehabilitation; Walking speed; Young Adult
• ISSN: 0269-2155; 1477-0873
• DOI: 10.1177/0269215509339875

Objective: To determine if treatment of longstanding complex regional pain syndrome type 1, focusing on functional improvement only while neglecting pain, results in clinical improvement of this syndrome. Design: Prospective description of a case series of 106 patients. Setting: Outpatient clinic for rehabilitation. Interventions: Physical therapy of the affected limb directed at a functional improvement only while neglecting the pain, was performed following an extensive explanation. Normal use of the limb between the treatments was encouraged despite pain. A maximum of five of these sessions were performed in three months. Measures: Radboud Skills Test was used to monitor functional improvement of the arms. Speed and walking distance was used as the measure of outcome for the legs. Results: The function of the affected arm or leg improved in 95 patients. Full functional recovery was experienced in 49 (46%) of them. A reduction in pain presented in 75 patients. In 23 patients functional recovery was reached despite an increase in pain. Four patients stopped early due to pain increase. Conclusions: Our results suggest that ‘pain exposure physical therapy’ is effective and safe for patients who are unresponsive to accepted standard therapies. Avoiding the use of a limb due to pain will result in loss of function. Forced usage of limbs restores the function, reverses these adaptive processes and leads to regain of control by practice with a reduction of pain in most cases.