Complex Regional Pain Syndrome type 1 (CRPS-1) is a debilitating condition that develops spontaneously or after physical injury, and is characterized by pain and sensory, autonomic, motor, ROM and/or trophic changes.

The exact cause of CRPS-1 is still not fully understood, but various pathophysiologic pathways have been identified. It has been shown that, in chronic musculoskeletal pain, patients’ beliefs about their pain are a disabling factor, and that pain-related fear and associated avoidance behaviours contribute to the development of chronic pain-related disability. See Fig 1.

According to the principles of the fear-avoidance model, pain catastrophizing and pain-related fear have to be treated first, in order to restore functional abilitie (Gradual Exposure Therapy). However, it may be possible that a more functionally directed approach, with the focus on increased motor activity and normal use of the affected limb in daily life, could also lead to improved patient outcomes.

PEPT is a patient-centred physical therapy, also know as the “Macedonian method”, developed by Ms. Shinka in 2003, and is based on the supposition that limited use or even non-use of an ex- tremity, whether or not caused by fear of movement or pain, can lead to disease deterioration

PEPT is tailored towards improving activities in daily life, using progressive-loading exercises, desensitization and “self-forced” use, in which patients have to encourage themselves to use their affected extremity, both during treatment exercises and in daily activities, without the use of medication.

Whereas GET focuses on fear, PEPT puts disuse at the centre.