# Neurocognitive Interventions Informed by Cognitive–Behavioral Therapy (CBT) Principles and Physical Exercise for Complex Regional Pain Syndrome: A Systematic Review

## TL;DR

This review shows that combining physical exercise and CBT-based neurocognitive interventions can help reduce pain and improve function in people with Complex Regional Pain Syndrome.

## Contribution

The study systematically evaluates the combined effectiveness of physical and CBT-based interventions for CRPS management.

## Key findings

- Aerobic exercise consistently reduced pain and improved function in CRPS patients.
- CBT-based neurocognitive interventions like mirror therapy and graded exposure decreased pain and improved independence.
- Combining physical and psychological approaches showed positive effects on pain and daily activity performance.

## Abstract

Background: Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that usually affects a limb following injury or surgery and is characterized by severe pain accompanied by sensory, motor, autonomic, and trophic disturbances. Methods: This systematic review aimed to synthesize the available evidence on the effectiveness of physical exercise and neurocognitive interventions grounded in cognitive–behavioral therapy (CBT) principles for the management of CRPS. A comprehensive search was conducted in Medline (via Ovid), LILACS, ScienceDirect, PEDro, OTseeker, and the Cochrane Central Register of Controlled Trials (CENTRAL). Eligible studies included clinical trials, cohort studies, and cross-sectional studies, whereas case reports, pediatric populations, and animal studies were excluded. Fifteen studies met the inclusion criteria. Results: The findings indicated that aerobic exercise was consistently associated with pain reduction and functional improvement. Neurocognitive interventions informed by CBT principles, such as mirror therapy and graded exposure, also demonstrated efficacy in decreasing pain and enhancing functional independence. Most studies supported the effectiveness of these approaches in the management of CRPS. Overall, both physical exercise and neurocognitive interventions grounded in CBT principles produced positive effects on pain modulation, physical function, and daily activity performance. Conclusions: These findings highlight the therapeutic potential of combining physical and psychologically informed interventions for the treatment of CRPS.