title: Physical therapy and cognitive-behavioral treatment for complex regional pain syndromes.
abstract: Complex regional pain syndromes (CRPS; type 1, reflex sympathetic dystrophy, and type 2, causalgia) involve persistent pain, allodynia, and vasomotor signs. We conducted a prospective, randomized, single-blind trial of physical therapy (PT) and cognitive-behavioral treatment for children and adolescents with CRPS. Children 8 to 17 years of age (n = 28) were randomly assigned to either group A (PT once per week for 6 weeks) or group B (PT 3 times per week for 6 weeks). Both groups received 6 sessions of cognitive-behavioral treatment. Assessments of pain and function were repeated at two follow-up time periods. Outcomes were compared at the three time points through the use of parametric or nonparametric analysis of variance and post hoc tests. All five measures of pain and function improved significantly in both groups after treatment, with sustained benefit evident in the majority of patients at long-term follow-up. Recurrent episodes were reported in 50% of patients, and 10 patients eventually received sympathetic blockade. Most children with CRPS showed reduced pain and improved function with a noninvasive rehabilitative treatment approach. Long-term functional outcomes were also very good.
authors.affiliation: Pain Treatment Service and the Department of Physical Therapy, Children's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Lee
authors.forename: Lisa
authors.initials: L
authors.lastname: Scharff
authors.forename: Navil F
authors.initials: NF
authors.lastname: Sethna
authors.forename: Claire F
authors.initials: CF
authors.lastname: McCarthy
authors.forename: Jennifer
authors.initials: J
authors.lastname: Scott-Sutherland
authors.forename: Alice M
authors.initials: AM
authors.lastname: Shea
authors.forename: Penny
authors.initials: P
authors.lastname: Sullivan
authors.forename: Petra
authors.initials: P
authors.lastname: Meier
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Masek
authors.forename: Charles B
authors.initials: CB
authors.lastname: Berde
mesh_terms: D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy; D020918:Complex Regional Pain Syndromes / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D018709:Statistics, Nonparametric