The value of interdisciplinary pain management in complex regional pain syndrome type I: a prospective outcome study.
BACKGROUND
Complex regional pain syndrome (CRPS) type I is a symptom complex of severe, chronic limb pain, often associated with allodynia, vasomotor, and sudomotor changes. Optimal management of this condition is not well understood. The role of a traditional, comprehensive pain management program with long-term follow-up has not been evaluated.


OBJECTIVE
To define the benefit of the interdisciplinary approach in patients with CRPS type I.


METHODS
Prospective, case series, outcomes evaluation.


METHODS
Patients with a diagnosis of CRPS type I entering the University Pain Center's intensive, outpatient pain management program were enrolled in an objective assessment study through the duration of the program, with a follow-up of 2 years. This program involved 4 weeks of interdisciplinary management comprised of 20 sessions of physical therapy, 20 sessions of occupational therapy, 12 sessions of water therapy, 20 sessions of group psychotherapy, stellate ganglion blocks, and drug therapy.


METHODS
Specific objective measurements of upper extremity function, sensation and strength over time, and functional status 2 years after program completion.


RESULTS
Upper extremity weight tolerance increased dramatically by 29-pounds (p<0.05). Function improved, with a 35 inch-pound gain in BTE (Baltimore Therapeutic Equipment) extension (p<0.005) and a 50 inch-pound increase in flexion (p<0.02). Jebsen-Taylor multifunctional testing (fine and gross motor skills) normalized from 72 to 48 seconds (p<0.04). Stable anxiety levels despite increased patient effort implied improved pain tolerance. At the 2-year follow up, 75% of the patients were employed.


CONCLUSIONS
Patients with CRPS type I may benefit from a 4-week outpatient pain management program emphasizing rehabilitation.
Singh
Gurwant
G
Department of Neurology, University Hospitals of Cleveland and Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
Willen
Seth N
SN
Boswell
Mark V
MV
Janata
Jeffrey W
JW
Chelimsky
Thomas C
TC