CRPS

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Diagnosis

Budapest Criteria

Management

Principles

The four pillars of management :

1. Patient information and education to support self-management.
2. Pain relief (medication and procedures).
3. Psychosocial and behavioural management.
4. Physical and vocational rehabilitation ( and activities of daily living and societal participation) .

A coordinated Multidisciplinary Program should therefore involve:

• Education
• Medical
• Physiotherapy and OT
• Psychological and Behavioural
• Societal and Vocational

Vocational and litigation support may be provided by specialist rehabilitation teams and, in other cases, these services are integrated into the regional pain management programme

• Active engagement of the patient/family in goal setting, goal review
• Control
  • the patient remains responsible for their own rate of progress.
• Understanding and insight:
  • how emotional stress, muscle tension and de-conditioning can increase pain experience.
  • how their own behaviours may serve to exacerbate pain experience.
• Learning:
  • self-management approach, including goal setting and pacing.
  • the right balance between doing too much and too little.
  • relaxation techniques, breathing exercises etc to reverse sympathetic arousal.
• Empowering the family:
  • encouraging individual to keep active

Medical Management

Investigation and confirmation of diagnosis:

• Pharmacological intervention (in conjunction with pain team wherever appropriate) to provide a window of pain relief.
• Reassurance that physical and occupational therapy are safe and appropriate.
• Provide medical follow-up to prevent iatrogenic damage through inappropriate referral.
• Support any litigation/compensation claim to its resolution and conclusion.(if desired and appropriate).

Psychosocial and Behavioural management

• Identify any psychological factors contributing to pain and disability.
• Treat anxiety and depression.
• Identify, explore and proactively address any internal factors (eg counter-productive behaviour patterns)or external influences (eg. perverse incentives, family dynamics etc) which may perpetuate disability/dependency.
• Consider needs of family/carers – provide psychological intervention/counselling where appropriate.
• Provide a practical problem-solving, goal-orientated approach (involving both the patient and their family) to reduce barriers and promote healthy functioning.

Physical management

Retrain normal body posture.

• Desensitisation – handling the affected part followed by passive stretching/isometric exercise.
• Progression to active isotonic exercise and then strength training.
• General body re-conditioning – cardiovascular fitness.
• Encourage recreational physical exercise and functional goals.
• Techniques to address altered perception and awareness of the limb, eg. mirror visual feedback training or graded motor imagery.

Activities of daily living and societal participation

• Support graded return to independence in activities of daily living with clear functional goals.
• Assessment and provision of appropriate specialist equipment/adaptations to support independence.
• Removal of inappropriate/unnecessary equipment.
• Adaptation of environment.
• Extend social and recreational activities in and outside the home.
• Workplace assessment/vocational re-training.

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Literature Review

Literature Review

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