Complex Regional Pain Syndrome Physiotherapy Treatment

Abstract

Background: Complex Regional Pain Syndrome (CRPS) can be a severe and debilitating condition. It usually develops after trauma or surgery. It causes significant disability and pain. It is thought to arise and persist as a consequence of a maladaptive pro-inflammatory response and disturbances in sympathetically-mediated vasomotor control, together with maladaptive peripheral and central neuronal plasticity. Type I (CRPS I), in which no specific nerve lesion is identified, and type 2 (CRPS II), where one can be determined. While it is recommended that people with CRPS be treated multimodally, there are not many studies on their effectiveness.

The objectives of this study were to evaluate the effectiveness and safety of physiotherapy intervention for treating pain and disability caused by CRPS Types I and II.

Our search methods were: Searches took place from the inception of our database to the 12th of February 2015. Also, additional sources online were searched to find unpublished trials as well as trials currently in progress.

Selection criteria: We included RCTs of physiotherapy interventions (including manual therapy, therapeutic exercise, electrotherapy, physiotherapist-administered education and cortically directed sensory-motor rehabilitation strategies) employed in either a stand-alone fashion or in combination, compared with placebo, no treatment, another intervention or usual care, or of varying physiotherapy interventions compared with each other in adults with CRPS I and II. Patients-centered outcomes, such as functional disability and pain intensity were our primary objectives.

Data collection and analysis. The data were collected and analysed by two independent authors who independently reviewed the eligible research and then extracted any relevant data from included RCTs. Both review authors conducted independent ‘Risk of bias assessments’ and assessed the quality of main outcomes using Grading of Recommendations Assessment. Development, and Evaluation (GRADE).

Results: The 18 RCTs included 739 participants and tested the efficacy a wide range of physiotherapy treatments. The evidence for physiotherapy as a treatment of CRPS I-related disability and pain was lacking. All but one of the trials included were at high risk for bias (15 trials), with three additional trials at an ‘unclear risk of bias. There were very few adverse events reported in included trials. The review excluded trials that had participants with CRPS II.

Authors’ conclusions: The best available data show that GMI and mirror therapy may provide clinically meaningful improvements in pain and function in people with CRPS I although the quality of the supporting evidence is very low. Multimodal physiotherapy is not available for people with CRPS I or II. High quality, large-scale RCTs of high quality are needed to assess the effectiveness of physiotherapy interventions in pain management and disability for people suffering with CRPS Type I and II. We will also be discussing future research, as well the implications of this for clinical practice.

Physiotherapy Role In The Crps

One of the best treatments for complex regional painful syndromes is physiotherapy. A series of research reports indicate towards the positive role of physiotherapy in the management of this disorder.

In fact, experts strongly suggest that the mainstay of the treatment modalities for CRPS lies in the fact that the pain associated with CRPS is not any form of damage and hence responds positively to graded physiotherapy.

Functional rehabilitation is the key function of physiotherapy for CRPS. Because CRPS can be caused by severe injuries or damages, it is essential that physiotherapy is focused on functional rehabilitation in order to treat the condition.

A physiotherapist’s main goal is to enable the patient to live an independent lifestyle after receiving pharmacological treatment. A physiotherapist is a person who helps patients to move by providing health promotion, pre-treatment, rehabilitation, and treatment.

The Approach

The non-invasive preventive, restorative and rehabilitative tools of physiotherapy ensure that the set goals of treatment of CRPS are met in a desirable manner.

These subheadings provide a basic overview on the approach to physiotherapy for complex regional pain syndrome.

Desensitization of the affected region – Using specific physiotherapy techniques, the area affected by CRPS needs to be desensitized to disable the perception of pain.

Isometric strengthening, mobilization and mobility – These are crucial for treating any physical injury. The isometric strengthening of and mobilization for the affected area are the next steps.

The steps stress loading, postural normization and aerobic conditioning are all important. They emphasize the need to exercise as well and on postural rehabilitation. The key to successful physiotherapy-based rehabilitation is good posture.

Functional rehabilitation and vocational therapy – These are the last steps in physiotherapy-based rehabilitation of CRPS. In order to reduce the full impact of the disorder it is crucial that the individual involved returns to work, and tries to regain maximum efficiency in normal activities.

.Complex Regional Pain Syndrome Physiotherapy Treatment

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