title: Safety of "pain exposure" physical therapy in patients with complex regional pain syndrome type 1.
abstract: "Pain exposure" physical therapy (PEPT) is a new treatment for patients with complex regional pain syndrome type 1 (CRPS-1) that consists of a progressive-loading exercise program and management of pain-avoidance behavior without the use of specific CRPS-1 medication or analgesics. The aim of this study was to investigate primarily whether PEPT could be applied safely in patients with CRPS-1. Twenty patients with CRPS-1 were consecutively enrolled in the study after giving informed consent. The diagnosis of CRPS-1 was defined using the Bruehl and Harden/IASP diagnostic criteria. CRPS-1 was diagnosed between 3 and 18 months after the inciting event (trauma). According to a multiple single-case design (baseline [A1], treatment [B], follow-up [A2]), multiple baseline and follow-up measurements were performed to evaluate changes in CRPS signs and symptoms and to assess functional parameters. When comparing the baseline with the follow-up phase, patients improved significantly with respect to pain on the visual analogue scale (57%), pain intensity (48%), muscle strength (52%), arm/shoulder/hand disability (36%), 10-meter walking speed (29%), pain disability index (60%), kinesiophobia (18%), and the domains of perceived health change in the SF-36 survey (269%). Three patients initially showed increased vegetative signs but improved in all other CRPS parameters and showed good functional recovery at follow-up. We conclude that PEPT is a safe and effective treatment for patients with CRPS-1. A progressive-loading exercise program and management of pain-avoidance behavior without the use of specific medication ("pain exposure" physical therapy) is safe and effective for patients with complex regional pain syndrome.
authors.affiliation: Department of Rehabilitation, Nijmegen Centre of Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Department of Orthopedic Surgery, Nijmegen Centre of Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Scientific Institute for Quality of Healthcare, Nijmegen Centre of Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Department of Surgery, Nijmegen Centre of Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Department of Anesthesiology, Pain and Palliative Medicine, Nijmegen Centre of Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Hendrik
authors.initials: H
authors.lastname: van de Meent
authors.forename: Margreet
authors.initials: M
authors.lastname: Oerlemans
authors.forename: Almar
authors.initials: A
authors.lastname: Bruggeman
authors.forename: Frank
authors.initials: F
authors.lastname: Klomp
authors.forename: Robert
authors.initials: R
authors.lastname: van Dongen
authors.forename: Rob
authors.initials: R
authors.lastname: Oostendorp
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Frölke
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000503:physiopathology; D004185:Disability Evaluation; D004487:Edema / Q000503:physiopathology; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D035002:Lower Extremity / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D010147:Pain Measurement / Q000379:methods; D010698:Phobic Disorders / Q000209:etiology / Q000523:psychology; D010808:Physical Examination; D026741:Physical Therapy Modalities; D011788:Quality of Life; D012019:Reflex Sympathetic Dystrophy / Q000473:pathology / Q000523:psychology* / Q000534:rehabilitation*; D012880:Skin Pigmentation / Q000502:physiology; D012881:Skin Temperature / Q000502:physiology; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology; D016138:Walking / Q000502:physiology; D055815:Young Adult