Purpose: The aim of this study was to investigate the efficacy of manual lymphatic drainage (MLD) combined with repetitive transcranial magnetic stimulation (rTMS) on the recovery of upper limb in patients with post-stroke complex regional pain syndrome (CRPS).
Methods: This pilot study was conducted with 54 patients with post-stroke CRPS. Patients were randomized into three groups: the MLD combined with rTMS group (MLD + rTMS group), the rTMS group and the sham-rTMS group. The results of numeric rating scale (NRS), volumetric measurement, Fugl-Meyer assessment of upper extremity (FMA-UE), CRPS severity score (CSS), generalized anxiety disorder-7 (GAD-7) and patient health questionnaire-9 (PHQ-9) before and after the intervention were analyzed.
Results: Fifty-four participants (37 males, 17 females; mean age 66.11 ± 8.43 years; range, 18 to 85) were included in the study. Among groups, improvements were statistically significant with superiority of rTMS + MLD group after treatment (p < 0.05). NRS, GAD-7, and PHQ-9 in the rTMS + MLD group improved more significantly than those in the rTMS group (p < 0.05).
Conclusion: MLD combined with rTMS has an add-on efficacy on the basis of rTMS therapy in post-stroke patients, especially in pain. MLD could also have an effect on anxiety and depression.
Keywords: Complex regional pain syndrome; manual lymphatic drainage; rehabilitation; repetitive transcranial magnetic stimulation; stroke.
The unclear pathogenesis of complex regional pain syndrome (CRPS) necessitates clinicians to implement tailored rehabilitation measures for its diverse symptoms.The central-peripheral rehabilitation model of manual lymphatic drainage combined with repetitive transcranial magnetic stimulation could help to further improve pain in post-stroke CRPS patients.