How effective is physiotherapy in the treatment of complex regional pain syndrome type I? A review of the literature

Complex regional pain syndrome (CRPS) is a debilitating pain disorder for which patients commonly receive physiotherapy. The objective of this literature review is to assess how effective physiotherapy is in the management of adult and childhood CRPS type I. An electronic literature search was performed of the databases AMED, Cinahl, Embase, Ovid Medline, Pubmed, PEDro and PsycINFO, from their inception to November 2004. Human subjects clinical trials, written in English, which could assist in answering the research question were included. Twenty-five (of 748) papers met the inclusion criteria and were reviewed. The review suggests that exercise, motor imagery and mirror feedback exercises, relaxation techniques, acupuncture, electroacupuncture, transcutaneous nerve stimulation and combined treatment programmes may help in the treatment of CRPS type I. However, since numerous methodological weaknesses (e.g. small sample sizes, not employing control groups, not evaluating findings against statistical tests) littered the limited literature, it was not possible to determine the effectiveness of individual treatments. Recommendations are made to develop the evidence base.