Contrast Compression Therapy for Post-Stroke Complex Regional Pain Syndrome

Post-stroke complex regional pain syndrome (CRPS), also known as shoulder-hand syndrome, is observed in more than 50% of patients who have experienced a stroke. This condition is typically classified as Type I CRPS due to the absence of identifiable peripheral nerve injury. Although the precise underlying mechanism remains unclear, biomechanical factors that cause mechanical instability of the shoulder joint and repetitive microtrauma are considered major risk factors for its development.

Clinically, post-stroke CRPS is characterized by severe pain involving both the shoulder and wrist, accompanied by symptoms such as edema, warmth, redness, limited range of motion, tenderness in the metacarpophalangeal joints, and in later stages, joint contractures that may cause significant functional impairment. The chronic nature of CRPS can lead to substantial limitations in upper extremity use, prolonged hospital stays, dependency in daily living activities, and increased overall rehabilitation costs, thereby reducing patients' quality of life.

Although various conservative treatments-including pharmacological agents, physical therapy, contrast water therapy (CWT), and sympathetic nerve blocks-are frequently used, the effectiveness, long-term safety, and accessibility of standardized treatment protocols remain limited. Traditional contrast water therapy aims to stimulate circulation and modulate inflammation by alternating vasodilation and vasoconstriction phases; however, modern contrast compression therapy enhances this principle by combining sequential thermal stimulation with active pneumatic compression. This combination aims to improve not only peripheral circulation but also lymphatic drainage and tissue oxygenation.

Contrast compression therapy has gained popularity in recent years, especially in orthopedic and sports rehabilitation, due to its potential benefits in controlling pain and edema. Technological advancements have enabled these systems to deliver precisely regulated temperature, pressure, and treatment durations, allowing for a more controlled and personalized approach compared to conventional methods. Despite promising results in musculoskeletal applications, no clinical trial to date has specifically evaluated the effects of contrast compression therapy in the neurological rehabilitation context, particularly for patients with post-stroke CRPS.

Therefore, this randomized controlled trial was designed to investigate whether adding contrast compression therapy to conventional rehabilitation provides additional benefits for pain control, edema reduction, functional recovery, and motor improvement in patients diagnosed with post-stroke CRPS, aiming to address an important gap in the current literature.

Inclusion criteria

• Age between 25 and 80 years
• First-ever stroke diagnosed within the previous 12 months
• Diagnosis of upper-extremity complex regional pain syndrome type I (CRPS-I) according to the Budapest clinical criteria
• Subacute-stage CRPS affecting the upper limb
• Mini-Mental State Examination (MMSE) score greater than 23
• Provided written informed consent

Exclusion criteria

• Unstable medical condition
• Hemispatial neglect
• Sensory or motor aphasia
• Shoulder subluxation
• CRPS due to causes other than stroke
• Bilateral CRPS-I
• History of psychotic disorder
• Coexisting neuropathic pain syndromes (e.g., diabetic neuropathy)
• Presence of open wounds in the treatment area