Scientific Tracks Abstracts: Int J Phys Med Rehabil
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. Discussion: Considering there is no evident therapy and the validity of the diagnosis is doubted, the results of this prospective case-series in combination with other results raise some important questions about aetiology, diagnosis and treatment.
Jan-Willem Ek studied medicine at the Erasmus University of Rotterdam. In the same place, he specialized as general practitioner. He worked several years at the University of Amsterdam and Groningen as coach and teacher. After he was confronted by accident with a treatment that seemed successful for long lasting CRPS type 1, he studied this syndrome and got interested in pain, especially chronic pain, in general. This resulted in a publication (ClinRehabil December 2009 vol. 23 no. 12 1059-1066) and a job at the rehabilitation department of the Bethesda Medical Center in Hoogeveen.