Sensory-focused treatment for the management of Complex Regional Pain Syndrome (CRPS) symptoms: A systematic review

Pnina Kitai1,2,3, Hadas Ofek4

1 Pnina Kitai, Ben Gurion University2 Padeh-Poria Medical Center
3 Sha’ar Haguf Physical Therapy Clinic
4 Hadas Ofek, Zefat Academic Collegehadasbarkolofek@gmail.com. 054-4666412
Background: Complex Regional Pain Syndrome (CRPS) is a progressive pain disorder that causes suffering and reduces quality of life. The currently used multidisciplinary treatment, which includes pharmacological, physical and emotional interventions, has been shown to have a limited effect. The main symptom is pain, with additional impaired sensory function including allodynia, hyperalgesia and hypoesthesia. Therefore, it has been suggested that sensory-focused therapy, which has been proven effective in treating other pain syndromes, could be used in physical therapy. The strategies employed in sensory-focused physical therapy are repeated exposure to stimuli or active sensory training.
Methods: A systematic review of the research literature was conducted, to consider the effectivity of sensory-focused treatment for the management of CRPS symptoms. The search for articles matching the inclusion criteria was conducted using the following databases: Pubmed, Cochrane, PEDro and ClinicalKey. Two researchers worked separately to review the articles for inclusion in the study and assessed their methodological quality and risk of bias using Cochrane Collaboration’s tool and the PEDro scale.
Results: Nine articles matched inclusion criteria; however they all were of poor methodological quality (PEDro scores: 2-4 out of 11). Hence, due to methodological variability and partial outcome reports, no meta-analysis was conducted. Decrease in pain was demonstrated in all active-sensory training studies, in addition to improvement in sensory function and in general performance variables. 
Discussion and conclusion: This review’s results suggest that sensory-focused therapy and specifically active sensory training can alleviate symptoms in people with CRPS. There is a need for further research of better methodological quality, with larger sample sizes and using specified outcome measures, to verify the usefulness of sensory-focused therapy in CRPS.
Keywords: systematic review, complex regional pain syndrome, treatment, sensory training, sensory rehabilitation, physical therapy