Scientific/Clinical Article| Volume 31, ISSUE 2, P238-249, April 2018

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Mechanism-specific rehabilitation management of complex regional pain syndrome: Proposed recommendations from evidence synthesis

Published:February 13, 2018DOI:


      • A spectrum of treatments of supported by varying levels of evidence have been proposed for complex regional pain syndrome (CRPS), including 4 different clinical practice guidelines, but gaps in evidence may still limit confidence in effect.
      • Considering physiological mechanisms related to the symptoms presented by a person with CRPS may inform hand therapists' selections of interventions for individual clients.
      • CRPS interventions may focus on peripheral mechanisms, central mechanisms, or both.
      • Approaches to rehabilitation management should be patient-centered and individually tailored to the clinical presentation.
      • As understanding of pathophysiological mechanisms continues to evolve, new innovations in rehabilitation should follow, and historical treatments without substantive evidence should be removed from therapists' toolkit.


      Study Design

      Narrative review.


      There are a variety of treatments with demonstrated effectiveness for the management of complex regional pain syndrome (CRPS). However given the variability in symptom presentation in this population, therapists may be unsure what treatments would be most effective for individual clients.

      Purpose of the Study

      To present a brief synthesis of the literature and propose a rehabilitation version of a mechanism-specific management algorithm to guide personalized treatment of CRPS.


      A systematic search of the literature was conducted to identify all randomized controlled trials, systematic reviews, and clinical practice guidelines addressing rehabilitation of CRPS. Results were reviewed independently by 2 reviewers and final selection of articles was reached by consensus, Data was extracted using standardized forms, and a single rater gave quality ratings. Both reviewers then used the extracted data to present a synthesis of the evidence categorized by the proposed mechanisms of effect.


      A total of 111 articles were retrieved and reviewed for inclusion; 49 were selected for data extraction. A synthesis of the key recommendations was compiled into a rehabilitation-specific version of the mechanism-based management algorithm proposed by Gierthmühlen et al (2014).


      Consideration of mechanism-appropriate rehabilitation interventions may assist therapists to select the most appropriate and effective treatments from the body of evidence supporting rehabilitation of CRPS.


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      JHT Read for Credit

      Quiz: #544

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • #1.
        A significant aspect of the article was
        • a.
          identifying the single best management intervention for CRPS sufferers
        • b.
          identifying the single most common cause of CRPS
        • c.
          a systematic review of the literature
        • d.
          presenting the rationale for referral to CHTs as opposed to OTs and PTs who are not credentialed in hand therapy
      • #2.
        The authors draw heavily on a review published by
        • a.
          Gierthmuhlen et al
        • b.
          Fess and Bell
        • c.
          MacDermid et al
        • d.
          Michlovitz and Fedorczyk
      • #3.
        The important Table 2 matches
        • a.
          patients’ symptoms to mechanisms
        • b.
          intensity of pain to extent of injury
        • c.
          physical findings to psychological profiles
        • d.
          treatments and outcomes to mechanisms
      • #4.
        One possible causative feature of certain cases of CRPS listed in the article is
        • a.
        • b.
          acute psychotic reaction
        • c.
          maladaptive plasticity
        • d.
          neoplasm within the carpal tunnel
      • #5.
        The authors recommend using treatment approaches to the management of CRPS based on the specific mechanism driving the individual patient’s pain
        • a.
        • b.
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