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Short- and long-term outcomes of children with complex regional pain syndrome type I treated with exercise therapy
D D Sherry1, C A Wallace, C Kelley
1Department of Pediatrics, University of Washington, Children's Hospital & Medical Center, Seattle 98105, USA. dsherry@u.washington.edu
Insights
Intensive exercise therapy effectively treats childhood complex regional pain syndrome type I (CRPS), with most children becoming symptom-free initially. Long-term outcomes show sustained improvement, with a low rate of persistent symptoms or dysfunction.
Area of Science:
- Pediatric Rehabilitation
- Pain Management
- Neurology
Background:
- Childhood complex regional pain syndrome type I (CRPS) presents significant challenges in physical function and quality of life.
- Effective, non-pharmacological treatment strategies are crucial for managing pediatric CRPS.
- Intensive, multidisciplinary approaches are often considered for complex cases.
Purpose of the Study:
- To evaluate the initial and long-term effectiveness of an intensive exercise therapy program for pediatric CRPS.
- To assess the rates of symptom resolution, recurrence, and functional recovery following treatment.
- To determine the durability of treatment effects over time.
Main Methods:
- Prospective follow-up study of 103 children diagnosed with CRPS.
- Intervention involved intensive daily exercise (aerobic, hydrotherapy, desensitization) for a mean of 14 days.
- Psychological evaluation and counseling were integrated, with no medications or modalities used.
Main Results:
- 92% of children achieved initial symptom freedom.
- At long-term follow-up (mean 5 years 3 months), 88% remained symptom-free.
- Recurrences were observed in 31% of initially recovered patients, predominantly within the first 6 months.
Conclusions:
- Intensive exercise therapy demonstrates high efficacy for initial treatment of childhood CRPS.
- The program is associated with a low incidence of long-term symptoms and functional impairment.
- Early intervention and comprehensive therapy are key to favorable outcomes in pediatric CRPS.
Objective:
To report the initial and long-term outcome after an intensive exercise therapy program for childhood complex regional pain syndrome, type I (CRPS).
Design:
Prospective follow-up.
Setting:
A children's hospital.
Subjects:
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).
Interventions:
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.
Main Outcome Measures:
Outcomes included pain, presence of physical dysfunction, or recurrent episodes of CRPS or other disproportional musculoskeletal pain.
Results:
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.
Conclusion:
Intense exercise therapy is effective in initially treating childhood CRPS and is associated with low rate of long-term symptoms or dysfunction.