What is it about?

Concerns often arise among both clinicians and patients regarding the potential negative consequences stemming from pain provocation during physiotherapy for Complex Regional Pain Syndrome (CRPS), despite clinical guidelines advocating for a departure from pain-contingent approach. To shed light on this matter, this narrative review critically examines the findings of six selected articles that explore exposure-based therapies. Remarkably, the available data fails to support the notion of significant long-term deterioration in symptoms or function, nor does it uncover any notable harms associated with pain provocation during CRPS physiotherapy. However, it is important to highlight that only one of the included studies placed primary emphasis on evaluating safety, while the reporting of potential harms in the remaining studies was inadequate, leading to a very low level of certainty in the available evidence.

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Why is it important?

Acknowledging the low level of certainty surrounding the available evidence, this narrative review offers a degree of support and reassurance regarding safety for clinicians and individuals living with complex regional pain syndrome who are willing to explore exposure-based therapies as one of the potential avenues for reducing disability and improving quality of life.


Writing this article was part of my journey to explore safe and effective treatment strategies for individuals living with complex regional pain syndrome (CRPS). At the beginning of my carrier, I was exposed to contradictory advice regarding pain-contingency. Some clinicians recommended some form of exposure, while other clinicians recommended avoiding pain provocation at all costs. Summarizing current evidence helped me to feel more grounded during therapy sessions and this new knowledge helped me and my patients to change our attitudes regarding pain in CRPS. In some people, this can help to break the fear-avoidance cycle and help them to live in a richer and more meaningful way. Exposure-based therapies may not be the preferred approach for every individual living with CRPS, but when used appropriately and in an individualized way, they can bring very significant change into people's lives.

Tomáš Kavka
Charles University in Prague

Read the Original

This page is a summary of: Harmful or safe? Exposure and pain provocation during physiotherapy of complex regional pain syndrome I: a narrative review, Journal of Back and Musculoskeletal Rehabilitation, May 2023, IOS Press,
DOI: 10.3233/bmr-220081.
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