How to treat complex regional pain syndrome in rehabilitation settings?

Complex regional pain syndrome is chronic neuropatic pain condition which usually arise after trauma. It is associated with some of the sensory, vasomotor, sudomotor, motor and trophic symptoms and sings. Due to variability of symptoms and long-lasting pain, these patients are hard to rehabilitate. They exhibit activity related fear and so have pronounced functional limitations. Adequate rehabilitation procedures, frequently long lasting, are essential for their optimal recovery, so rehabilitation specialist should constantly update their knowledge on this issue. Emerging researches on pathophysiology, diagnosis and treatment of CRPS created a need for systematization of current body of evidence. Available researches on efficacy of different treatment options are still insufficient to create precise therapy guidelines, so future researches are needed in order to promote better rehabilitation outcomes.

Quality of life and functional capacity one year after coronary artery bypass graft surgery.

OBJECTIVES: To analyze functional capacity and quality of life of patients one year after coronary artery bypass graft surgery (CABG) and identify factors that influence them in order to accomplish maximal recovery. METHODS: Observational study included 89 patients undergoing elective CABG, who were tested preoperatively and one year after operation using Short form 12 item health survey (SF-12), Duke Activity Status Index (DASI) questionnaire and questionnaire regarding participation in rehabilitation program. RESULTS: After one year, DASI and quality of life-physical component summary score (SF-12 PCS) significantly improved (p < 0.001; p < 0.05). No statistically significant improvement in mental component summary has been registered. In domains of physical component summary, only general health was significantly better (p < 0.05). There was moderate correlation of SF-12 PCS postoperatively with SF-12 mental component summary (SF-12 MCS) preoperatively. DASI scores preoperatively and postoperatively are found to be significantly higher in men comparing to women (p < 0.05). Multiple regression analysis found DASI preoperatively (R2 = 0.62, beta = 0.42, p < 0.05) and age (beta = -0.53, p < 0.05) to be significant predictors of DASI postoperatively in women. Enrollment in rehabilitation program didn't influence DASI and SF-12 scores one year after CABG. CONCLUSIONS: Although functional capacity and physical component of quality of life improved, factors that influence them still remain unclear. It seems that mental health status and personality profile, as well as the alternative modalities of rehabilitation, might play important role in long lasting effects of improvement.