School of Rehabilitation, Université de Montréal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada; Centre Professionnel d'Ergothérapie, Montreal, Quebec, Canada.
Centre Professionnel d'Ergothérapie, Montreal, Quebec, Canada.
J Hand Ther. 2018 Apr-Jun;31(2):255-264. doi: 10.1016/j.jht.2018.01.012.
Case report.
Conventional rehabilitation alone may not be effective in reducing symptoms in some patients with complex regional pain syndrome.
This case report portrays the benefits of a new tailored rehabilitation program for a 39-year-old patient suffering from upper limb complex regional pain syndrome with severe touch-evoked pain (static mechanical allodynia).
This patient had previously received conventional rehabilitation for a year and a half including physical and nonsurgical medical interventions that did not improve symptoms or function. In the search for an alternative, this patient was referred to occupational therapy to try a tailored rehabilitation program, drawing on multiple strategies used sequentially according to the patient's tolerance and symptom evolution. During this 22-month program, the following methods were added (listed chronologically): somatosensory rehabilitation of pain method, graded motor imagery, pain management modalities, active mobilizations, strengthening exercises, and task simulation. The patient successively showed resolution of mechanical allodynia, decreased pain, reduction of tactile hypesthesia and improvement in active range of motion, strength, and function. These improvements allowed him to return to work.
This suggests that a tailored rehabilitation program combining somatosensory rehabilitation of pain method, graded motor imagery and more conventional approaches could improve symptoms and functional status in patients with upper limb complex regional pain syndrome, even with persistent refractory symptoms.
The addition of the somatosensory rehabilitation of pain method and the graded motor imagery approach to conventional therapy could be considered in cases of complex regional pain syndrome that do not respond to conventional rehabilitation alone.
病例报告。
对于一些患有复杂性区域疼痛综合征的患者，单纯的常规康复可能无法有效减轻症状。
本病例报告描述了一种新的个体化康复方案对一名患有上肢复杂性区域疼痛综合征伴严重触诱发痛（静态机械性感觉过敏）的 39 岁患者的益处。
该患者此前已接受了为期一年半的常规康复治疗，包括物理治疗和非手术医疗干预，但症状和功能均无改善。为寻找替代治疗方法，该患者转介至职业治疗师，尝试个体化康复方案，根据患者的耐受程度和症状演变，逐步采用多种策略。在这 22 个月的治疗中，陆续增加了以下方法（按时间顺序列出）：疼痛感觉康复方法、分级运动想象、疼痛管理模式、主动活动、强化锻炼和任务模拟。患者逐渐出现机械性感觉过敏缓解、疼痛减轻、触觉迟钝减轻以及主动活动范围、力量和功能改善。这些改善使他得以重返工作岗位。
这表明，结合疼痛感觉康复方法、分级运动想象和更常规方法的个体化康复方案可能会改善上肢复杂性区域疼痛综合征患者的症状和功能状态，即使是存在持续难治性症状的患者。
对于那些对单纯常规康复治疗无效的复杂性区域疼痛综合征病例，可考虑在常规治疗的基础上增加疼痛感觉康复方法和分级运动想象方法。
