title: Pain exposure physical therapy may be a safe and effective treatment for longstanding complex regional pain syndrome type 1: a case series.
abstract: 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.
  
  
  METHODS
  Prospective description of a case series of 106 patients.
  
  
  METHODS
  Outpatient clinic for rehabilitation.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Rehabilitation Medicine, Bethesda Hospital, Hoogeveen.
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Ek
authors.forename: Jan C
authors.initials: JC
authors.lastname: van Gijn
authors.forename: Han
authors.initials: H
authors.lastname: Samwel
authors.forename: Jan
authors.initials: J
authors.lastname: van Egmond
authors.forename: Frank P A J
authors.initials: FP
authors.lastname: Klomp
authors.forename: Robert T M
authors.initials: RT
authors.lastname: van Dongen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005081:Exercise Therapy; D005240:Feasibility Studies; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D020127:Recovery of Function; D012019:Reflex Sympathetic Dystrophy / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult