Physical and occupational therapies in complex regional pain syndrome Type I

In patients with CRPS-I there are varying manifestations in the development and progression of the syndrome. It may lead to minimal impairment (i.e., loss of strength or pain with exposure to cold) or it may lead to major impairment, resulting in chronic invalidism. In extreme cases CRPS-I may even lead to amputation. There is a lack of knowledge in the efficacy of most treatments, time dependent symptoms of CRPS-I, natural course, prognostic factors and psychological and psychosomatic aspects of CRPS-I. In general the scientific background for therapy and for paramedical treatment particular is lacking. It may appear strange that without much evidence rehabilitation has such an important emphasis in these guidelines. The fact of the matter is that there are essentially no evidence-based therapies, and to not treat patients until 'hard science' is available is nihilistic. The rehabilitation method, especially physical and occupational therapies (PT and OT), provide a varied and balanced empirical approach, which at the present moment is the only way to proceed. In this paper a review of all published PT and OT papers are discussed.