Treatment

For the purpose of this discussion, hereafter the term CRPS also refers to pediatric studies that used the previous definition of RSD. There are numerous diverse therapies reported in the literature for management of CRPS in children, but none has been examined in well-controlled randomized controlled trials to be reliably effective. There is only one prospective randomized controlled trial that has examined the effectiveness of physical therapy and cognitive-behavioral treatment to improve pain and overall (89 percent) excellent improvement in functional status for short-term symptoms with a duration of 1-18 weeks.63 Most practitioners recommend early intervention to prevent refractoriness, disability, and to enhance favorable outcome. The initial therapeutic strategies include patient and family education, physical therapy, and cognitive-behavioral therapy.45[V], 58[V], 62[V], 63[II]

The primary goal of management is to restore normal function through activity irrespective of severity of the pain as follows:

• Aggressive step-wise mobilization of the affected limb by eliminating guarding postures and assistive devices, posture correction, encouraging range of motion, flexibility exercise and gradual weight bearing, normalizing motor, gait control and increase ambulation, and strengthening hand grip and dexterity to avoid undesirable immobilization contractures.

• Improve overall physical deconditioning through age-specific aerobic training programs to reduce fatigue, increase endurance, and avoid reinjury.

• Desensitize allodynia by warm/cold contrast bath, hydrotherapy, compression sleeves to reduce edema and touch intolerance, and gentle massage by self-touch of sensitive skin with application of inert creams/gels.

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