{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T04:08:38Z","timestamp":1773288518237,"version":"3.50.1"},"reference-count":39,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T00:00:00Z","timestamp":1753401600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Complex regional pain syndrome (CRPS) is a disabling pain condition, which is distinct from other pain syndromes by the presence of autonomic dysfunction and regional inflammatory changes. Objectives: To explore the impact of pharmacological treatment strategies, specifically scheduled, on-demand dosing regimens versus lack of medical treatment, on pain-related and functional outcomes in rehabilitation for individuals with CRPS. Methods: A total of 32 participants with CRPS were assigned to three treatment groups depending on analgesic treatment during the course of complex rehabilitation. Pre- and post-rehabilitation assessments were conducted using validated measures, including the Numerical Rating Scale (NRS) for pain, the Short-Form McGill Pain Questionnaire (SF-MPQ), PainDETECT, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the Lower Extremity Functional Scale (LEFS). Results: Significant improvements in pain and upper limb function (DASH scores) were observed across all groups (p &lt; 0.05). No statistically significant changes were found in lower limb function (LEFS). Between-group comparisons revealed significant differences in post-treatment pain scores (SFMPQ-B), particularly between groups with a constant treatment regimen and those without treatment. Conclusions: There were no statistically significant changes compared to different treatment regimen groups. The constant treatment group showed slightly better average improvements in pain and disability compared to other groups. Statistically significant improvements in all CRPS patients were observed in pain-related and functional measures.<\/jats:p>","DOI":"10.3390\/ph18081114","type":"journal-article","created":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T16:06:17Z","timestamp":1753459577000},"page":"1114","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tailoring Treatment in Complex Regional Pain Syndrome: A Comparative Study of Therapeutic Approaches in Complex Rehabilitation"],"prefix":"10.3390","volume":"18","author":[{"given":"Iana","family":"Andreieva","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Faculty of Medicine, Warsaw Medical University, Sparta\u0144ska 1, 02-637 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9902-5969","authenticated-orcid":false,"given":"Beata","family":"Tarnacka","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Faculty of Medicine, Warsaw Medical University, Sparta\u0144ska 1, 02-637 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6212-1850","authenticated-orcid":false,"given":"Adam","family":"Zalewski","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Eleonora Reicher National Institute of Geriatrics, Rheumatology and Rehabilitation, Sparta\u0144ska 1, 02-637 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justyna","family":"Wi\u015bniowska","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Eleonora Reicher National Institute of Geriatrics, Rheumatology and Rehabilitation, Sparta\u0144ska 1, 02-637 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Zhu, H., Wen, B., Xu, J., Zhang, Y., Xu, L., and Huang, Y. (2024). Efficacy and Safety of Pharmacological Treatment in Patients with Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis. Pharmaceuticals, 17.","DOI":"10.3390\/ph17060811"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1007\/s11916-023-01124-3","article-title":"Complex Regional Pain Syndrome (CRPS) and the Value of Early Detection","volume":"27","author":"Harnik","year":"2023","journal-title":"Curr. Pain. Headache Rep."},{"key":"ref_3","unstructured":"Dey, S., Guthmiller, K.B., and Varacallo, M. (2022). Complex Regional Pain Syndrome. StatPearls, StatPearls Publishing."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.hcl.2021.02.013","article-title":"Complex Regional Pain Syndrome and Distal Radius Fracture: Etiology, Diagnosis, and Treatment","volume":"37","author":"Dutton","year":"2021","journal-title":"Hand Clin."},{"key":"ref_5","first-page":"49","article-title":"Complex Regional Pain Syndrome","volume":"104","author":"Lloyd","year":"2021","journal-title":"Am. Fam. Physician"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1093\/pm\/pnae126","article-title":"The efficacy of an interdisciplinary pain management program for complex regional pain syndrome compared to low back pain and chronic widespread pain: An observational study","volume":"26","author":"Bean","year":"2025","journal-title":"Pain. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3534","DOI":"10.1093\/rheumatology\/keac060","article-title":"Pharmacological treatment in adult patients with CRPS-I: A systematic review and meta-analysis of randomized controlled trials","volume":"61","author":"Fassio","year":"2022","journal-title":"Rheumatology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1759720X211014020","DOI":"10.1177\/1759720X211014020","article-title":"Intramuscular neridronate for the treatment of complex regional pain syndrome type 1: A randomized, double-blind, placebo-controlled study","volume":"13","author":"Varenna","year":"2021","journal-title":"Ther. Adv. Musculoskelet. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Parinder, A., Lyckeg\u00e5rd Finn, E., Dahlin, L.B., and Nyman, E. (2025). Associated factors, triggers and long-term outcome in Complex Regional Pain Syndrome (CRPS) in the upper limb\u2014A descriptive cross-sectional study. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0320263"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e1956","DOI":"10.1002\/msc.1956","article-title":"Rehabilitation Interventions for Adults with Complex Regional Pain Syndrome: A Scoping Review Protocol","volume":"22","author":"Pique","year":"2024","journal-title":"Musculoskelet. Care"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Li, T.S., Wang, R., Su, X., and Wang, X.Q. (2023). Effect and mechanisms of exercise for complex regional pain syndrome. Front. Mol. Neurosci., 16.","DOI":"10.3389\/fnmol.2023.1167166"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/AJP.0000000000001089","article-title":"The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome: A Systematic Review and Meta-analysis","volume":"39","author":"Shafiee","year":"2023","journal-title":"Clin. J. Pain."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"218","DOI":"10.5535\/arm.19084","article-title":"Understanding the Rehabilitation Needs of Korean Patients With Complex Regional Pain Syndrome","volume":"44","author":"Kim","year":"2020","journal-title":"Ann. Rehabil. Med."},{"key":"ref_14","first-page":"91","article-title":"Efficacy of an intensive multimodal rehabilitation program in adult patients affected by complex regional pain syndrome type 1 (CRPS 1): A randomized controlled trial","volume":"9","author":"Falcone","year":"2024","journal-title":"Int. Phys. Med. Rehab J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1007\/s40265-022-01685-4","article-title":"From a Symptom-Based to a Mechanism-Based Pharmacotherapeutic Treatment in Complex Regional Pain Syndrome","volume":"82","author":"Mangnus","year":"2022","journal-title":"Drugs"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S125","DOI":"10.12701\/jyms.2023.00360","article-title":"Algorithm for multimodal medication therapy in patients with complex regional pain syndrome","volume":"40","author":"Chang","year":"2023","journal-title":"J. Yeungnam Med. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1080\/14656566.2023.2218032","article-title":"Perspectives on the pharmacological management of complex regional pain syndrome","volume":"24","author":"Norton","year":"2023","journal-title":"Expert. Opin. Pharmacother."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1080\/14737175.2024.2307490","article-title":"An update on the pharmacotherapeutic options for complex regional pain syndrome","volume":"24","author":"Iolascon","year":"2024","journal-title":"Expert. Rev. Neurother."},{"key":"ref_19","first-page":"CD009416","article-title":"Interventions for treating pain and disability in adults with complex regional pain syndrome","volume":"4","author":"Wand","year":"2013","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_20","first-page":"e18910","article-title":"Use of Ketamine Infusions for Treatment of Complex Regional Pain Syndrome: A Systematic Review","volume":"13","author":"Chitneni","year":"2021","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3247","DOI":"10.2147\/IJGM.S419239","article-title":"Pharmacological Methods of Pain Management: Narrative Review of Medication Used","volume":"16","author":"Alorfi","year":"2023","journal-title":"Int. J. Gen. Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"De Rosa, F., Giannatiempo, B., Charlier, B., Coglianese, A., Mensitieri, F., Gaudino, G., Cozzolino, A., Filippelli, A., Piazza, O., and Dal Piaz, F. (2023). Pharmacological Treatments and Therapeutic Drug Monitoring in Patients with Chronic Pain. Pharmaceutics, 15.","DOI":"10.3390\/pharmaceutics15082088"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s40122-020-00218-9","article-title":"Pharmacological Management of Adults with Chronic Non-Cancer Pain in General Practice","volume":"9","author":"Bonezzi","year":"2020","journal-title":"Pain. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1071\/HC19066","article-title":"Chronic pain: Good management of practical pain control strategies is associated with being older, more health activated and having better mental health","volume":"12","author":"Budge","year":"2020","journal-title":"J. Prim. Health Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1016\/j.pain.2011.01.005","article-title":"Time-scheduled vs. pain-contingent opioid dosing in chronic opioid therapy","volume":"152","author":"Merrill","year":"2011","journal-title":"Pain"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1093\/pm\/pnz356","article-title":"Understanding Buprenorphine for Use in Chronic Pain: Expert Opinion","volume":"21","author":"Webster","year":"2020","journal-title":"Pain. Med."},{"key":"ref_27","first-page":"2349","article-title":"Scheduled analgesic regimen improves rehabilitation after hip fracture surgery","volume":"471","author":"Chin","year":"2013","journal-title":"Orthop. Relat. Res."},{"key":"ref_28","first-page":"e36861","article-title":"Early Neuropathic Treatment May Prevent the Chronic Stage of Complex Regional Pain Syndrome Type II (CRPS II)","volume":"15","author":"Caradonna","year":"2023","journal-title":"Cureus"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Van de Vusse, A.C., Stomp-Van Den Berg, S.G., Kessels, A.H., and Weber, W.E. (2004). Randomised controlled trial of gabapentin in Complex Regional Pain Syndrome type 1 [ISRCTN84121379]. BMC Neurol., 4.","DOI":"10.1186\/1471-2377-4-13"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.sjpain.2016.05.039","article-title":"A randomized controlled trial of amitriptyline versus gabapentin for complex regional pain syndrome type I and neuropathic pain in children","volume":"13","author":"Brown","year":"2016","journal-title":"Scand. J. Pain"},{"key":"ref_31","first-page":"CD007076","article-title":"Pregabalin for neuropathic pain in adults","volume":"1","author":"Derry","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"608","DOI":"10.12968\/bjcn.2019.24.12.608","article-title":"Gabapentin for chronic neuropathic pain in adults","volume":"24","author":"Moore","year":"2019","journal-title":"Br. J. Community Nurs."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"189","DOI":"10.2217\/pmt-2020-0060","article-title":"Use of anticonvulsants and antidepressants for treatment of complex regional pain syndrome: A literature review","volume":"11","author":"Javed","year":"2021","journal-title":"Pain. Manag."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.pediatrneurol.2014.01.015","article-title":"Pregabalin Treatment of a Patient with Complex Regional Pain Syndrome","volume":"54","author":"Basgul","year":"2016","journal-title":"Pediatr. Neurol."},{"key":"ref_35","first-page":"e76324","article-title":"Complex Regional Pain Syndrome: Diagnosis, Pathophysiology, and Treatment Approaches","volume":"16","author":"Netto","year":"2024","journal-title":"Cureus"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1093\/pm\/pnac046","article-title":"Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 5th Edition","volume":"23","author":"Harden","year":"2022","journal-title":"Pain. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2346","DOI":"10.1097\/j.pain.0000000000002245","article-title":"The Valencia consensus-based adaptation of the IASP complex regional pain syndrome diagnostic criteria","volume":"162","author":"Goebel","year":"2021","journal-title":"Pain"},{"key":"ref_38","unstructured":"Curran, P. (2018). Practical Hydrotherapy, a Manual for Students and Practitioners. Sagwan Press."},{"key":"ref_39","first-page":"S6","article-title":"Mechanism of Peripheral Nerve Stimulation in Chronic Pain","volume":"21","author":"Lin","year":"2020","journal-title":"Pain. Med. Malden Mass."}],"container-title":["Pharmaceuticals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8247\/18\/8\/1114\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:16:23Z","timestamp":1760033783000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8247\/18\/8\/1114"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,25]]},"references-count":39,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["ph18081114"],"URL":"https:\/\/doi.org\/10.3390\/ph18081114","relation":{},"ISSN":["1424-8247"],"issn-type":[{"value":"1424-8247","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,25]]}}}