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Patients with complex regional pain syndrome need better support

23 July 2018

A new guideline published today by the Royal College of Physicians in partnership with 28 other organisations, including the British Psychological Society, says patients with complex regional pain syndrome (CRPS) need better diagnosis, treatment and management of their condition from a wide variety of healthcare professionals.

CRPS is a condition in which patients experience persistent severe and debilitating pain in a limb, often accompanied by other symptoms like sensitivity to touch, swelling and lack of movement. 

Complex regional pain syndrome in adults: UK guidelines for diagnosis, referral and management in primary and secondary care provides guidance on diagnosis, treatment, management and support for patients in a wide variety of clinical settings - GP practice, physiotherapy and occupational therapy practice, surgical practice, rheumatology, neurology and neurosurgery, sport and exercise medicine, dermatology, pain medicine, rehabilitation medicine, emergency medicine and long-term care.

As CRPS is rare and can be confused with other causes of pain, patients often experience delays in diagnosis and getting the right treatment early. CRPS often begins after an injury to the limb, but the cause of the continuing pain and other symptoms is unknown. Treatments can address the symptoms and help patients manage the condition but not the underlying cause.

Most patients will improve spontaneously within about a year, bur some can be left with unrelenting pain for many years. The guidelines say more research is needed into the causes of CRPS and other chronic pain.

The report underlines the need for multidisciplinary support to manage CRPS and outlines the ‘four pillars of care’ that underpin management:

  • Education
  • Pain relief
  • Physical rehabilitation
  • Psychological intervention

The primary aims are to reduce pain, preserve or restore function, and enable patients to manage their condition and improve their quality of life. Prompt diagnosis and early treatment are considered best practice in order to avoid secondary physical problems associated with disuse of the affected limb and the psychological consequences of living with undiagnosed chronic pain.

CRPS pain is sometimes so bad that a number of patients request amputation. This is generally not advisable because it can make the situation worse, but is addressed in the surgical section of the guidance with a detailed pathway allowing healthcare professionals to approach this issue.

The report includes a series of appendices including patient information and leaflets, a diagnostic checklist, advice to patients on daily living and a list of NHS centres with experience in treating patients with CRPS.

Alison Clarke, Chair of our Professional Practice Board, said:

“The society was delighted to be involved in the production of this guideline. CRPS is not as widely known as it should be and I hope we have gone some way to putting that right.

I am pleased that the guideline gives a prominent role to psychology in the understanding of this condition and to psychologists in helping those who suffer from it.”


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