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Fluidotherapy, an adjunct treatment for complex regional pain syndrome: Two case studies

Libby Rosenstein, OTR/L1, Judith Scheman, PhD2, Michelle Wilson, OTR/L3, and Edward Covington, MD2. (1) Department of Occupational Therapy - C22, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, (2) Department of Psychiatry and Psychology - Section of Pain Medicine, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, (3) Department of Occupational Therapy - C22, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195

Fluidotherapy is a dry whirlpool utilizing convection heat with particles of corn husks. This treatment is believed to increase collagen tissue extensibility, and facilitate increased range of motion, circulation and desensitization. For these reasons we utilized fluidotherapy as adjunct treatment for 2 patients with lower extremity complex regional pain syndrome (CRPS). Both patients had failed previous treatment without fluidotherapy including: spinal cord stimulators, epidural steroid injections, nerve blocks and tunneled epidural catheters. Patient 1 was a 15-year-old female with 4-month duration CRPS. On admission to the Chronic Pain Rehabilitation Program, pain was 7/10, and she was wheelchair dependent. Patient 2 was a 29-year-old male with 2-year duration CRPS. On admission to the Chronic Pain Rehabilitation Program, pain was 7/10, and he was unable to tolerate room air temperature that he perceived as extremely cold. Patient 1 received a team approach treatment that included almost daily fluidotherapy. She quickly acclimated to the fluidotherapy with transmucosal fentanyl during treatment. Following 16 days of treatment, she exhibited decreased pain/edema, increased range of motion, was fully ambulatory, and her pain was 2/10. Oral opioids were discontinued, and shortly after discharge, the epidural catheter with fentanyl was removed. Patient 2 elected to discontinue team treatment through the Chronic Pain Rehabilitation Program after 9 days. He did continue with occupational therapy, including fluidotherapy and daily living skills training. He initially used a blanket or heater for his ankle and foot regularly. He had applied for disability, and was off his feet 22 hours a day. By the end of treatment, he was playing basketball, was able to tolerate outdoor winter temperatures, his pain was 4/10, and he was referred to a work hardening program. We believe that fluidotherapy shows promise, should be considered as an adjunct treatment for CRPS, and that further investigation is warranted.