CRPS / RPS

THIS DOCUMENT IS WRITTEN AS A GENERAL GUIDE FOR HOSPITAL STAFF. IT IS THE PROPERTY OF FND AWARE NZ, AND INCLUDES RECOMMENDATIONS FROM THE ROYAL COLLEGE OF PHYSICIANS (RCP)

For hospital staff caring for patients with Complex Regional Pain Syndrome (CRPS), a step-by-step approach focusing on pain management, physical therapy, and psychological support is crucial. This includes educating patients about CRPS, providing gentle pain relief, implementing physical therapy exercises, and offering psychological counseling. 

1. Diagnosis and Early Interventions:

Early Recognition:

Be aware that CRPS can develop after an injury, surgery, or stroke, and the pain may be disproportionate to the initial injury, according to the Mayo Clinic. 

Clinical Assessment:

Utilize the "Budapest criteria" to aid in diagnosis, focusing on pain disproportionate to the injury and symptoms in sensory, vasomotor, sudomotor/oedema, and motor/trophic categories. 

Early Intervention:

Begin pain management and physical therapy as soon as possible, as early intervention is crucial for better outcomes, according to the Royal College of Physicians (RCP). 

2. Pain Management:

Pain-Relieving Medications:

Prescribe appropriate medications for pain relief, such as NSAIDs, opioids, or medications for neuropathic pain. 

Gentle Movement:

Encourage gentle movement and activity, as inactivity can worsen CRPS. 

Physical Therapy:

Implement physical therapy to improve range of motion, strength, and function. 

Desensitization Therapy:

Help patients reduce sensitivity in the affected limb through desensitization techniques. 

3. Physical Rehabilitation:

Gentle Exercises:

Design a program of gentle exercises, including stretches, weight-bearing exercises, and exercises in water. 

Mirror Therapy:

Use mirror therapy to retrain the brain and improve movement in the affected limb. 

Graded Motor Imagery:

Employ graded motor imagery techniques to help patients mentally practice movements. 

Occupational Therapy:

Work with occupational therapists to modify daily activities and use assistive devices. 

4. Psychological Support:

Counselling and Therapy:

Refer patients to counselling or psychotherapy for emotional support and coping strategies. 

Addressing Depression and Anxiety:

Screen for and address depression, anxiety, and post-traumatic stress disorder, which can be common in CRPS. 

Support Groups:

Encourage patients to join support groups to connect with others with similar experiences. 

5. Hospital Care Specifics :

Gentle Handling: 

Move patients with care, avoiding sudden movements or bumps that can worsen pain. 

Avoiding Ice: 

Do not apply ice to the affected limb, as it can worsen symptoms. 

IV Access: 

When drawing blood or inserting IV lines, use the smallest gauge needle and topical numbing cream. 

Elevate Affected Limbs:

Encourage patients to elevate affected limbs when resting or sleeping. 

Hypoallergenic Materials: 

Use hypoallergenic materials to prevent skin irritation. 

Comfort Measures: 

Provide comfort measures such as warm blankets or pillows, according to Healthify. 

Pain Education: Provide patients with education about CRPS, its treatment, and how to manage their symptoms. 

By following these steps, hospital staff can provide comprehensive and compassionate care for patients with CRPS, maximizing their chances for pain relief and functional improvement. 

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