New guidelines for complex regional pain syndrome (CRPS) have been developed for health professionals working in primary and secondary care. These guidelines provide greater clarity for the diagnosis and management of the syndrome, as well as recommendations for treatment and referral of patients with CRPS.
CRPS is a poorly understood condition, which tends to occur after an injury to a limb. Pain is the primary problem, and is associated with some limb changes and limb dysfunction, and often resulting psychological distress. One in seven patients continue to experience unrelenting pain and physical impairment and these patients are considered to have a long-term condition. They report among the lowest quality of life scores known in medicine. There is no proven cure for CRPS, and the causes are still unknown.
The guidelines are necessary as CRPS is rare and can mimic many other health conditions – it is therefore not easy to pick it up, for those health professionals, who see it only rarely. Prompt diagnosis and early treatment are considered best practice. If CRPS remains untreated, patients may develop secondary physical problems associated with disuse of the affected limb, and psychological effects of living with undiagnosed chronic pain.
Guideline recommendations are specialty-specific hence targeted towards clinicians who work in different health specialties and in a variety of clinical settings. An integrated, interdisciplinary treatment approach is advised in order to mitigate the reduction of a patient’s quality of life.
Commenting on the benefit of improved guidelines for CRPS, chair of the Guideline development panel, Dr Andreas Goebel said:
The various healthcare professionals involved in the management of patients with CRPS previously had no common platform to work from and so good care was difficult to achieve. This has now changed. The new guidelines are supported by a broad group of professionals, who agree on the coherent guidance and recommendations outlined. We therefore expect the guidelines will help patients to be seen earlier, and treated promptly with the best methods available.
The guidelines were developed in association with the Pain Relief Foundation by a panel of UK experts representing different professional bodies. The recommendations were developed through panel consensus and expert opinion with reference to existing literature. Where possible, recommendations were informed by evidence from the reviews of randomised controlled trials (RCTs).
- These guidelines were initiated by Dr Andreas Goebel and Dr Chris Barker in association with the Pain Relief Foundation and were developed by a UK panel of experts representing a variety of healthcare specialties and professions.
- The panel was support by, and had representation from the Royal College of General Practitioners, the Royal College of Physicians, the College of Occupational Therapists, the British Association of Dermatologists, the British Health Professionals in Rheumatology, the British Orthopaedic Association, the British Pain Society, the British Psychological Society, the British Society for Rehabilitation Medicine, the British Society for Rheumatology, the Chartered Society of Physiotherapy, the Physiotherapy Pain Association, the Society of British Neurological Surgeons, and the Pain Relief Foundation. With additional support from the Royal College of Radiologists, the Society of Chiropodists and Podiatrists, The Association of Orthopaedic Practitioners, the British Association of Hand Therapists, the British Association of Plastic, Reconstructive and Aesthetic Surgeons and the Association of British Neurologists; with endorsement from the British Society of Rheumatologists and British Health Professionals in Rheumatology.
- The diagnosis of CRPS is based on clinical examination and is given when patients meet the ‘Budapest’ diagnostic criteria.
- The Royal College of Physicians (RCP) is an independent professional membership organisation and registered charity, representing over 27,000 physicians in the UK and internationally. The RCP is relentless in its pursuit of improvements in healthcare and the health of the population. We achieve this by enhancing and harnessing the skills, knowledge and leadership of physicians in setting challenging standards and encouraging positive change based on sound evidence.