"
Pain exposure"
physical therapy (
PEPT) is a new treatment for patients with
complex regional pain syndrome type 1 (CRPS-1) that consists of a progressive-loading exercise program and management of
pain-avoidance behavior without the use of specific CRPS-1 medication or
analgesics. The aim of this study was to investigate primarily whether
PEPT could be applied safely in patients with CRPS-1. Twenty patients with CRPS-1 were consecutively enrolled in the study after giving informed consent. The diagnosis of CRPS-1 was defined using the Bruehl and Harden/IASP diagnostic criteria. CRPS-1 was diagnosed between 3 and 18 months after the inciting event (
trauma). According to a multiple single-case design (baseline [A1], treatment [B], follow-up [A2]), multiple baseline and follow-up measurements were performed to evaluate changes in CRPS signs and symptoms and to assess functional parameters. When comparing the baseline with the follow-up phase, patients improved significantly with respect to
pain on the visual analogue scale (57%),
pain intensity (48%), muscle strength (52%), arm/shoulder/hand disability (36%), 10-meter walking speed (29%),
pain disability index (60%),
kinesiophobia (18%), and the domains of perceived health change in the SF-36 survey (269%). Three patients initially showed increased vegetative signs but improved in all other CRPS parameters and showed good functional recovery at follow-up. We conclude that
PEPT is a safe and effective treatment for patients with CRPS-1. A progressive-loading exercise program and management of
pain-avoidance behavior without the use of specific medication ("
pain exposure"
physical therapy) is safe and effective for patients with
complex regional pain syndrome.