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

Clin Rehabil. 2009 Dec;23(12):1059-66. doi: 10.1177/0269215509339875.


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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Exercise Therapy*
  • Feasibility Studies
  • Humans
  • Middle Aged
  • Pain Measurement
  • Prospective Studies
  • Recovery of Function
  • Reflex Sympathetic Dystrophy / physiopathology
  • Reflex Sympathetic Dystrophy / therapy*
  • Young Adult