Short- and Long-term Outcomes of Children with Complex Regional Pain Syndrome Type I Treated with Exercise Therapy

TLDR

The study reports on the initial and long‑term outcomes of an intensive exercise therapy program for children with CRPS type I. Children received a daily 4‑hour aerobic and functional exercise regimen, 1–2 hours of hydrotherapy, and desensitization, with no medications, and were followed prospectively for up to five years. Ninety‑two percent of children became symptom‑free initially, and among those followed for more than two years, 88% remained symptom‑free with only a few recurrences, demonstrating the therapy’s effectiveness and low long‑term morbidity.

Abstract

To report the initial and long-term outcome after an intensive exercise therapy program for childhood complex regional pain syndrome, type I (CRPS).Prospective follow-up.A children's hospital.We followed 103 children (87 girls; mean age = 13.0 years) with CRPS. Forty-nine subjects were followed for more than 2 years (mean = 5 years 3 months).An intensive exercise program (most received a daily program of 4 hours of aerobic, functionally directed exercises, 1-2 hours of hydrotherapy, and desensitization). No medications or modalities were used. All had a screening psychological evaluation, and 79 (77%) were referred for psychological counseling.Outcomes included pain, presence of physical dysfunction, or recurrent episodes of CRPS or other disproportional musculoskeletal pain.The mean duration of exercise therapy was 14 days, but over the past 2 years has decreased to 6 days. Ninety-five children (92%) initially became symptom free. Of those followed for more than 2 years, 43 (88%) were symptom free (15, or 31 %, of these patients had had a reoccurrence), 5 (10%) were fully functional but had some continued pain, and 1 (2%) had functional limitations. The median time to recurrence was 2 months; 79% of the recurrences were during the first 6 months after treatment.Intense exercise therapy is effective in initially treating childhood CRPS and is associated with low rate of long-term symptoms or dysfunction.