Complex Regional Pain Syndrome (CRPS) Clinic

Specialist neuroscience-based treatment, training and menotring to tackle CRPS in London

“I began my treatment with Richmond nearly a year ago now. My pain had spread from my foot right through to my back and whole arm. I was finding general day to day activities extremely hard and I believe if I had not been treated my Richmond my only option as I saw it was to give up some of my work and take extra pain killers. Within weeks and months of Richmond helping me I regained a lot of movement in my arm and the pain was reducing, I was able to continue with work and I felt much less worried about my condition. Richmond gave me many techniques physically and coping strategies mentally. I am a music conductor and my conducting was improving hugely through visualisation techniques, these techniques even made me a much more effective conductor…and this I never expected. I have slowly regained control of my life and I am feeling positive about the future, since seeing Richmond I have not had a major flare up for a year! I will always continue to see Richmond as he has changed my life and CRPS is no longer in control of me!” GS – Surrey

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New CRPS Guidelines available here | Visit our CRPS Blog here

Complex Regional Pain Syndrome (CRPS) was first recognised during the Civil War, then known as causalgia. Since then the condition has been re-named as Reflex Sympathetic Dystrophy (RSD) and more recently, complex regional pain syndrome or CRPS. CRPS can be a particularly painful and limiting problem that affects quality of life in many ways. The modern biopsychosocial approach that we provide addresses the biology of the pain and other symptoms, the psychological impact, including the influence of stress, anxiety and negative thinking about the condition, and the social effects such as work, home-life and the limits that CRPS can put upon physical activities.

Modern and on-going research helps us to understand the biology of CRPS and the influences upon this biology. For example, we know about the changes in the peripheral nervous system, the brain, the immune system and the sympathetic nervous system that contribute to CRPS. There are local effects in the tissues and altered activity in the nerves and blood vessels that together with the changes in the brain and spinal cord can explain the signs and symptoms. Having a greater understanding means that we can tackle the problem with understanding, desensitising therapies, graded activity and using the latest neuroscience based therapies that target the brain.

Types of CRPS

There are two types of CRPS, type I and type II, the criteria of the International Association for the Study of Pain (IASP)

Type I diagnostic criteria:

  1. The presence of an initiating noxious event or a cause of immobilization
  2. Continuing pain, allodynia (perception of pain from a nonpainful stimulus), or hyperalgesia disproportionate to the inciting event
  3. Evidence at some time of oedema, changes in skin blood flow, or abnormal sudomotor activity in the area of pain
  4. The diagnosis is excluded by the existence of any condition that would otherwise account for the degree of pain and dysfunction

Type II diagnostic criteria:

  1. The presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve
  2. Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of pain
  3. The diagnosis is excluded by the existence of any condition that would otherwise account for the degree of pain and dysfunction

** The main difference is the identification of a nerve injury

There are a range of signs and symptoms including:

  1. Pain – this can vary enormously in severity, description, quality, location, pattern
  2. Altered sensation – numbness, paraesthesia (pins & needles)
  3. Temperature change – heat, cold
  4. Size – swelling can vary from minute to minute on occasion; there can also be a sense of swelling that is not apparent when compared to the other side, for example the feeling of ‘sausage fingers’
  5. Stiffness in the tissues
  6. Sweating changes (sudomotor)
  7. Loss of function – reduced strength, position sense, control of movement
  8. Altered sense of self – limb feels detached, belonging to someone else; these are common feelings and due to changes in the nervous system that creates an altered perception of your body, especially in the affected region
  9. Other – there are many descriptions that patients give relating to symptoms, feelings, sense and pain and we encourage this expression as this is your unique story

Treatment

Treatment programmes are physiotherapy-led at our clinics. However, if during the assessment or treatment process we identify particular issues that we believe require medical or psychological input, we can arrange this for you swiftly. We work closely with several pain consultants and psychologists who provide excellent care.

Our treatment programmes are designed to promote deep understanding of CRPS, to gradually develop healthy movement and function, to augment a normal sense of the body and to reduce the pain and sensitivity. Science has told us that pain is a brain experience in response to a perceived threat. Tackling this by reducing the threat with informational medicine, giving a meaning to the pain and suffering, validating your experience and providing the latest treatment strategies is our primary concern. This includes neuroscience-based therapies such as the Graded Motor Imagery programme, sensory training and cognitive techniques, alongside movement and exercise therapies, hands-on treatment when appropriate, effective strategies for day-to-day living, skills to deal with flare-ups and other techniques that focus on the integrated function of body, brain, mind and immune system.

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