Short- and long-term outcomes of children with complex regional pain syndrome type I treated with exercise therapy

Objective: To report the initial and long-term outcome after an intensive e xercise 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 C RPS. Forty-nine subjects were followed for more than 2 years (mean = 5 year s 3 months). Interventions: An intensive exercise program (most received a daily program of 4 hours of aerobic, functionally directed exercises, 1-2 hours of hydro therapy, and desensitization). No medications or modalities were used. All had a screening psychological evaluation, and 79 (77%) were referred for ps ychological counseling. Main Outcome Measures: Outcomes included pain, presence of physical dysfunc tion, or recurrent episodes of CRPS or other disproportional musculoskeleta l pain. Results: The mean duration of exercise therapy was 14 days, but over the pa st 2 years has decreased to 6 days. Ninety-five children (92%) initially be came symptom free. Of those followed for more than 2 years, 43 (88%)were sy mptom 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 functiona l Limitations. The median time to recurrence was 2 months; 79% of the recur rences were during the first 6 months after treatment. Conclusion: Intense exercise therapy is effective in initially treating chi ldhood CRPS and is associated with low rare of long-term symptoms or dysfun ction.