gms | German Medical Science

Background: Complex Regional Pain Syndrome type 1 (CRPS-1) is a musculoskeletal complication in post-stroke patients (PSP) and is commonly seen in the first 3 months [1].

Aim: To investigate the efficacy of contrast bath (CB) and underwater pulsed ultrasound (UPUS) on pain, clinical features of CRPS and upper limb functions in PSP.

Method: PSP with CRPS-1 were scanned retrospectively. Inclusion criteria were as follows: 40- to 80-year-old first-time stroke survivors, stroke course over 1.5 months, clinically diagnosed CRPS-1 in the ipsilateral upper extremity. Of the 20 patients that enrolled, 10 had received 15 sessions of CB (4:1 min ratio, 30 min/day) whereas the other 10 had received 15 sessions of UPUS (1 MHz frequency, 1.5 watt/cm2 intensity, pulse pattern 1:1, 5 min/day). All patients had the same conventional rehabilitation program. 3 records (baseline, end of treatment, 1-month follow-up) were obtained and inspected for Visual Analog Scale (VAS), clinical features of CRPS (edema, trophic changes, asymmetrical sweating, difference in temperature and color, hyperalgesia, allodynia); range of motion (ROM), modified Ashworth scale (MAS), Brunnstrom recovery stage and Fugl-Meyer sensorimotor assessment of upper extremity.

Results/findings: Both modalities were found equally effective on spontaneous and activity-induced pain (p<0.025). In terms of clinical features of CRPS-1, Fugl-Meyer (except the hand subdivision in US group), Brunnstrom and MAS, there was no statistically significant difference at in-group and between-group comparisons (p>0.025). Regarding ROM, there was statistically significant improvement in metacarpophalangeal joint-passive extension in CB group and shoulder-active flexion in US group.

Discussion and conclusions: Since both modalities were equally effective on pain in CRPS-1, UPUS may be a good alternative to CB with its fixed treatment features.