By: Crissy Fiori, SPT
(Chrissy is a student physical therapist from Chatham University in Pittsburgh, Pa. )
A recent article about complex regional pain syndrom (CRPS) by Meent et al., published in PAIN, focused on using “pain exposure” physical therapy (PEPT) for the management of CRPS type 1 without the use of medication. Treatment included a progressive-loading exercise program, desensitization, and cognitive-behavioral techniques. Since pain relief was not the primary treatment goal, patients were warned that their pain may increase during or after activity, but that it would not cause tissue damage. Progressive-loading exercises revolved around the body part specific to the patient’s pain, and included active and passive movements to maintain joint mobility and muscle strength. Desensitization techniques included self- massage and forced use of the affected extremity. Cognitive-behavorial therapy revolved around motivating the patients to be more active, discouraging complaints about pain, and maintaining the home exercise programe of active and passive movements.
Results showed that patient’s improved significantly in regards to pain in various areas including: 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 heath change in the SF-36 survey (269%).
van de Meent H, Oerlemans M, Bruggeman A, et al. Safety of “pain exposure” physical therapy in patients with complex regional pain syndrome type 1. Pain 2011; 152: 1431-1438.