The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome: A Systematic Review and Meta-analysis.

Complex regional pain syndrome causes persistent pain, swelling, and disability, often after an injury or stroke, and there is long-standing uncertainty about which rehabilitation approaches actually help. This systematic review and meta-analysis pulled together 33 randomized controlled trials testing conservative treatments like mirror therapy, graded motor imagery, pain exposure therapy, and aerobic exercise, comparing them against usual physical therapy or sham treatments. The broad picture is mixed: a few approaches, including mirror therapy and graded motor imagery for patients with CRPS after stroke, and pain exposure therapy or aerobic exercise added to physical therapy, showed large improvements in pain and disability up to six months, but this was based on low-quality evidence.

For most other treatments studied, the evidence was too uncertain to draw conclusions either way. What makes this notable is the sheer scale of trials reviewed against how little confident guidance exists. The main limitation is quality: most included studies had a high risk of bias, meaning these encouraging signals need replication in stronger trials before they can be relied upon.

If you or someone you know has complex regional pain syndrome, a painful condition that can develop after injury or stroke, you may already know how limited the treatment guidance can feel. This review looked at 33 studies testing various rehabilitation approaches, from mirror therapy and imagined movement exercises to exposure-based pain therapy and aerobic exercise, to see what actually helps with pain and daily function. The findings suggest a few approaches, particularly mirror therapy and a movement-imagery program for people with this condition after a stroke, along with pain exposure therapy and aerobic exercise added to physical therapy, showed large improvements in pain and disability lasting up to six months.

However, the researchers rated this evidence as low quality, meaning it is not fully certain and could change with better studies. For most other treatments examined, the evidence was too weak or inconsistent to say whether they help or not. This does not mean those treatments don't work, only that the current research cannot answer the question reliably yet.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review and meta-analysis screened 751 records and included 33 randomized controlled trials evaluating conservative interventions for CRPS, published between 1995 and 2021. Risk of bias was low in only 2 studies, unclear in 8, and high in 23, which substantially limits confidence in pooled and individual trial results. Using GRADE, the authors rated evidence as low quality for several promising signals: mirror therapy added to conventional stroke rehabilitation and a graded motor imagery program compared with routine rehabilitation were associated with large improvements in pain and disability up to 6-month follow-up in poststroke CRPS-1 patients.

Pain exposure therapy and aerobic exercise as adjuncts to physical therapy were similarly associated with large pain improvements at the same follow-up point, also rated low quality. For all other targeted interventions compared with conventional physical therapy or sham treatments, the evidence was rated very uncertain regarding effects on pain and disability. Given the predominance of high risk-of-bias studies and low-certainty ratings even for the more favorable findings, these results should be interpreted as hypothesis-generating rather than definitive.

The authors explicitly note an ongoing need for higher-quality trials to inform conservative CRPS management.