The Royal College of Physicians (RCP) guidelines for complex regional pain syndrome (CRPS) in adults are now available. This document has been produced to improve the diagnosis, treatment and referrals for CRPS in a range of settings.
Clearly there is a need for much improved recognition. Many people whom I see with CRPS tell me about healthcare professionals who have minimal knowledge of the condition. In the public realm there is also a lack of understanding. Changing this situation will take time, effort and perseverance, however we at Specialist Pain Physio Clinics and CRPS UK are seeking to help to move forwards via the recent CRPS conference and other mediums such as blogs and education sessions. In the labs there are some great pieces of research being undertaken, looking at the underpinning mechanisms so that we can target these more effectively with treatment strategies and pharmacology.
On a personal note, I see CRPS as a condition affecting many aspects of life for the individual. On this basis, the argument for using the biopsychosocial model is strong. We are understanding more and more about the biology, the psychological influences and the social impact of complex pain that includes CRPS. Each presentation is fundamentally different. We all have our own ‘life story’ to date that influences how we respond to pain and injury. The context of the pain and suffering varies enormously. Sometimes a movement will hurt, but repeat it on another day, in a different room, with a different person and in a different mood, and the resulting ‘output’, i.e. the pain, can be different. This understanding permits us to create dynamic, flexible and contemporary treatment programmes that are designed to ‘train’ the brain. This top-end approach seeks to change the sensitivity by reducing the perceived threat and gradually restoring normal motor control patterns from the planning stages through to the actual movements; e.g. graded motor imagery. At the tissue end, ‘bottom-up’, we seek to nourish with safe movements, again in differing contexts to match how we live normally. And this is a key point: normalcy. This is often lost with a life taken over by pain and consequential suffering. Seeking to change this takes courage, perseverance, practice and commitment to use Lorimer’s words, and in doing so we are creating an opportunity for normalcy.
It is a time for optimism. We can change our language and talk about treating pain rather than managing pain. We can look forwards at new and effective avenues for better and healthier living with greater understanding of pain, the brain and how we can use this knowledge for great benefit.
For further information on our treatment programmes for CRPS and other complex pains, please visit the Specialist Pain Physio Clinics website.