[Comparison of manual lymph drainage with physical therapy in complex regional pain syndrome, type I. A comparative...

Sympathetic blockage and physiotherapy are among the most effective treatment approaches for the complex regional pain syndrome (CRPS). It is important to institute the treatment as early as possible in order to avoid major functional limitations of the affected limb. Unfortunately, there is a paucity of vigorously applied randomised or placebo-controlled trials for these therapeutic approaches. A prospective randomised study of 35 outpatient clinic patients with type I complex regional pain syndrome of the lower extremities lasting less than 6 months is described. One of two treatments, exercise alone or exercise in combination with manual lymph drainage, was applied for six weeks, three times a week, to the affected limb. Clinical and subjective parameters for pain, swelling, temperature, and range of motion were evaluated. Manual lymph drainage was chosen as adequate therapy for oedema reduction, whereas exercise was applied as standard therapy for contracture prophylaxis in reflex sympathetic dystrophy. Both groups were asked not to use analgesics but received extensive instructions for avoiding pain. Significant improvements in clinical parameters were observed in both groups, but no significant effect between treatment groups was found. Pain measurement alone with a verbal rating scale showed a tendency towards greater pain reduction in the group receiving lymph drainage. The results indicate that, during the first 6 months of complex regional pain syndrome type I, manual lymph drainage provides no additional benefit when applied in conjunction with an intensive exercise program.