THORACIC MANIPULATION and COMPLEX REGIONAL PAIN SYNDROME
Condition: Complex Regional Pain Syndromes
MeSH terms: Complex Regional Pain Syndromes; Reflex Sympathetic Dystrophy; Syndrome; Somatoform Disorders
Study type: Interventional

Summary: 
      To compare the effect of combined thoracic manipulation (TM) and traditional physical therapy
      treatment (TPT) versus TPT treatment alone on pain severity at rest and functional disability
      in patients with type 1 complex regional pain syndrome (CRPS I) post-upper limb trauma.
    

Detailed description: 
      Complex regional pain syndrome (CRPS) is a chronic state of pain that is frequently triggered
      by an injury and is characterized by a variable combination of sensory, motor, vasomotor, and
      sudomotor symptoms, in the affected limb..the frequency of CRPS after injury was 3.8-7.0 %
      within four months of fracture. The highest prevalence occurs in the age group of 40 to 60
      years. The pathophysiology of CRPS is still controversial, but a recent study has shown that
      up to 70% of patients with CRPS have anti-autonomic immunoglobulin G (IgG) autoantibodies
      associated with autonomic disorders in their serum CRPS, increasing the probability of these
      antiautonomic antibodies contributing to the pathophysiology of CRPS. Under normal
      conditions, sympathetic behavior does not affect the discharge of nociceptors; but
      nociceptors tend to be under the control of the sympathetic nervous system (SNS) in the case
      of CRPS. This is referred to as pain maintained sympathetically. Conservative treatments for
      CRPS I have traditionally focused on pain reduction through pharmacology, desensitization
      therapy, transcutaneous electrical stimulation (TENS), and thermal modalities and function
      restoration through active, passive, and strengthening exercises of the arm.

      Patients with arm CRPSI also show postural deviations related to the arm's defensive role.
      During all upright tasks, this posture reduces trunk motion and can have effects such as
      reduced thoracic intervertebral mobility. Near to the thoracic costovertebral and
      zygapophyseal joints are the sympathetic chain ganglia that innervate the upper limb. It may
      be probable that the sympathetic chain ganglia affected by thoracic dysfunction arising from
      joint or soft tissue restriction and may be related to the distal symptoms in CRPS. Thus,
      thoracic spine manipulation can be an aid to the overall treatment of the symptoms in
      patients with CRPS I. There is no study involving a control group in the available studies.
      As with all case studies, while the findings might be interesting for future research. our
      study is the first study to investigate the impact of thoracic manipulation in patients with
      CRPS1 by comparing between the control group and the experimental group.
    

Intervention name(s): Traditional physical therapy programe
Intervention type(s): Other
Intervention description(s): thoracic manipulation spine at the level of T3 and T4 facet joints (Maitland (screw) technique grade V). Using hypothenar eminence of hands, applying direct downward pressure and additional force-directed caudal with one hand and cephalic with the other hand on the transverse processes.
Other intervention name(s): Thoracic manipulation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment