Pain exposure physical therapy may be a safe and effective treatment for longstanding complex regional pain syndrome type 1: a case series

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. Design: Prospective description of a case series of 106 patients. Setting: Outpatient clinic fo...

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Veröffentlicht in:Clinical rehabilitation 2009-12, Vol.23 (12), p.1059-1066
Hauptverfasser: Ek, Jan-Willem, van Gijn, Jan C, Samwel, Han, van Egmond, Jan, Klomp, Frank PAJ, van Dongen, Robert TM
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container_end_page 1066
container_issue 12
container_start_page 1059
container_title Clinical rehabilitation
container_volume 23
creator Ek, Jan-Willem
van Gijn, Jan C
Samwel, Han
van Egmond, Jan
Klomp, Frank PAJ
van Dongen, Robert TM
description 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. Design: Prospective description of a case series of 106 patients. Setting: Outpatient clinic for rehabilitation. Interventions: 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. Measures: 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.
doi_str_mv 10.1177/0269215509339875
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Design: Prospective description of a case series of 106 patients. Setting: Outpatient clinic for rehabilitation. Interventions: 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. Measures: 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.</description><identifier>ISSN: 0269-2155</identifier><identifier>EISSN: 1477-0873</identifier><identifier>DOI: 10.1177/0269215509339875</identifier><identifier>PMID: 19906762</identifier><identifier>CODEN: CEHAEN</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adolescent ; Adult ; Aged ; Analgesics ; Anesthesiology ; Chronic pain ; Exercise Therapy ; Feasibility Studies ; Humans ; Limbs ; Middle Aged ; Nervous system ; Pain ; Pain Measurement ; Physical therapy ; Physiotherapy ; Prospective Studies ; Recovery ; Recovery of Function ; Reflex Sympathetic Dystrophy - physiopathology ; Reflex Sympathetic Dystrophy - therapy ; Rehabilitation ; Walking speed ; Young Adult</subject><ispartof>Clinical rehabilitation, 2009-12, Vol.23 (12), p.1059-1066</ispartof><rights>The Author(s), 2009.</rights><rights>SAGE Publications © Dec 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c394t-8333a95b8457b1fbc33b1feaab2c850559925402521b5f381daca2921e7e43793</citedby><cites>FETCH-LOGICAL-c394t-8333a95b8457b1fbc33b1feaab2c850559925402521b5f381daca2921e7e43793</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0269215509339875$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0269215509339875$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,12846,21819,27924,27925,30999,31000,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19906762$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ek, Jan-Willem</creatorcontrib><creatorcontrib>van Gijn, Jan C</creatorcontrib><creatorcontrib>Samwel, Han</creatorcontrib><creatorcontrib>van Egmond, Jan</creatorcontrib><creatorcontrib>Klomp, Frank PAJ</creatorcontrib><creatorcontrib>van Dongen, Robert TM</creatorcontrib><title>Pain exposure physical therapy may be a safe and effective treatment for longstanding complex regional pain syndrome type 1: a case series</title><title>Clinical rehabilitation</title><addtitle>Clin Rehabil</addtitle><description>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. 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Design: Prospective description of a case series of 106 patients. Setting: Outpatient clinic for rehabilitation. Interventions: 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. Measures: 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. 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subjects Adolescent
Adult
Aged
Analgesics
Anesthesiology
Chronic pain
Exercise Therapy
Feasibility Studies
Humans
Limbs
Middle Aged
Nervous system
Pain
Pain Measurement
Physical therapy
Physiotherapy
Prospective Studies
Recovery
Recovery of Function
Reflex Sympathetic Dystrophy - physiopathology
Reflex Sympathetic Dystrophy - therapy
Rehabilitation
Walking speed
Young Adult
title Pain exposure physical therapy may be a safe and effective treatment for longstanding complex regional pain syndrome type 1: a case series
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