RCP guidelines find patients with complex regional pain syndrome need better support

The RCP's updated guidelines for complex regional pain syndrome (CRPS) state that adult patients need better diagnosis, treatment and management of their condition from a wide variety of healthcare professionals.

Published in partnership with 28 other medical organisations, the guidelines provide information on diagnosis, treatment, management and support for patients in a wide variety of clinical settings - GP practice, physiotherapy/occupational therapy practice, surgical practice, rheumatology, neurology and neurosurgery, sport and exercise medicine (SEM), dermatology, pain medicine, rehabilitation medicine, emergency medicine and long-term care.

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.

Dr Andreas Goebel, chair of the CRPS guideline development panel, said:

I am delighted that these guidelines are supported by so many different organisations representing the patients’ treating healthcare professionals; the guidelines will help to ensure coherent, transparent and safe care for patients with this often very painful condition.

Professor Candy McCabe, chair of the CRPS UK Clinical and Research Network, said:

I am delighted to support the launch of these new guidelines. People with CRPS have the potential to benefit greatly from an early diagnosis and prompt initiation of healthcare interventions and rehabilitation. However, the lack of knowledge of CRPS within the general public and NHS can delay this care pathway.

These guidelines help to raise the profile of CRPS and provide an excellent evidence-based framework to support healthcare professionals in delivering timely and appropriate care.

Notes to editors

Further quotes

Dr Mick Serpell of the British Pain Society said:

These revised CRPS Guidelines have distilled and incorporated the most recent published scientific evidence and feedback from clinicians involved in the field of CRPS. They add further clarity to a very confusing condition, and are a very welcome advance for healthcarers and patients alike.

The Pain Relief Foundation is proud to be able to support the launch of the new CRPS guidelines and to help raise awareness of this very complex and painful condition.

The Faculty of Sport and Exercise Medicine are pleased to support the new complex regional pain syndrome (CRPS) guidelines published by the Royal College of Physicians in London. The guidelines will help to ensure safe care for patients with this often unbearably painful debilitating condition.

Sharon Gillespie, member of the CRPS UK Clinical and Research Network, said: 

I am delighted to represent the British Association of Hand Therapists (BAHT) in the launch of these guidelines. They are an invaluable tool for health care professionals. Due to the lack of knowledge of CRPS, signposting GPs to these will support timely, evidence based management, particularly in acute CRPS.

It was an honour to represent BAPRAS on the committee updating the national guidelines on CRPS. I anticipate that they will facilitate earlier diagnosis of CRPS, prompt treatment with modalities that are supported by evidence, and improved multidisciplinary care of patients with this rare and challenging condition.’ – James Henderson, consultant plastic surgeon and representative of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)

Contact

For further information and to arrange interviews please contact RCP head of PR Linda Cuthbertson by phone on 020 3075 1254 or 07798 777919, or by email at linda.cuthbertson@rcplondon.ac.uk.

About CRPS

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. 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, however 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.

About the guidelines

These guidelines were developed by a panel of experts with support from, representation and endorsement by the Royal College of General Practitioners, the Royal College of Physicians, the Faculty of Pain Medicine of the Royal College of Anaesthetists, the Royal College of Occupational Therapists, the British Orthopaedic Association, the British Pain Society, the British Psychological Society, the British Society of Rehabilitation Medicine, the Chartered Society of Physiotherapy, the Directorate of Defence Rehabilitation, the Physiotherapy Pain Association, the Society of British Neurological Surgeons, the Royal College of Emergency Medicine, the British Association of Plastic, Reconstructive and Aesthetic Surgeons, the Faculty of Occupational Medicine, the British Society for Surgery of the Hand, the British Association of Hand Therapists and the Pain Relief Foundation.

Also supported and endorsed by: the Association of Orthopaedic Practitioners, the Faculty of Sport and Exercise Medicine and the College of Podiatry.

With additional support from the British Association of Dermatologists, the British Society for Rheumatology, Royal College of Radiologists, the Vascular Society, the Association of British Neurologists and the British Society of Clinical Neurophysiology. Patients with complex regional pain syndrome (CRPS) and their relatives contributed to the development process.