Download CRPS private patient and overseas patient information leaflet

Bath Centre for
Pain Services – Complex
Regional Pain Syndrome
(CRPS) Service
Royal National Hospital for Rheumatic Diseases
Information for Private
and Overseas Patients
Aiming to improve the quality of
life for those with CRPS, through
education and physical rehabilitation
and support them in achieving their
optimum functional potential.
Version 2.2
Date: March 2015
Author: CRPS Team
Review Date: April 2016
WHAT IS COMPLEX REGIONAL PAIN SYNDROME?
Complex Regional Pain Syndrome (CRPS) is a term used to describe a
collection of symptoms where pain in a limb (usually a single limb) is the
major problem. Pain may start for no apparent reason or following injury to
the limb (such as a fracture). Whereas pain would normally settle as the
injury heals, in CRPS intense pain continues and spreads beyond the
original site of the injury. Other features of CRPS include altered
temperature and colour changes and impaired movement of the painful
limb.
CRPS can be difficult to diagnose as there is no single diagnostic test and
no cure currently exists. Research has shown that the average timescale
between onset of symptoms and diagnosis is currently two years.
Appropriate diagnosis and early intervention from a specialist
multidisciplinary team (MDT) is crucial to reduce the long-term effects of
this complex condition which can have a significant impact on a person,
affecting all areas of their life and that of their family.
THE SPECIALIST
COMPLEX REGIONAL PAIN SYNDROME SERVICE
At the Royal National Hospital for Rheumatic Diseases, Our specialist
multidisciplinary team is highly experienced in rehabilitating people with
Complex Regional Pain Syndrome. Established as one of the first
specialist services, we have over ten years’ experience in treating CRPS
and receive referrals from the UK and abroad. We are internationally
renowned for our research in CRPS, which underpins our treatment.
Our highly specialised team deliver CRPS specific care by providing
appropriate diagnosis, assessment and treatment of CRPS and offer a
residential rehabilitation programme tailored to the individual needs of the
person. Our service offers:
• National and international referrals
• Prompt and timely specialist intervention
• CRPS specific treatment tailored to the needs of the individual patient
by highly specialist health professionals
• Rehabilitation underpinned by evidence and in line with Royal College
of Physicians CRPS clinical guidelines
A typical CRPS assessment & treatment package includes:
• Detailed assessment and consultation by a Professor in Pain
Sciences and Pain Medicine Consultant
• Assessment of rehabilitation needs by a senior Occupational
Therapist/ Physiotherapist and Health Psychologist
• Diagnostic investigations
• Two-week inpatient CRPS specific treatments tailored specifically to
the patient’s needs
• Ongoing support and expertise, following inpatient programme
The Expert Team
We offer a Consultant Nurse and Pain Medicine-led service, comprising:
• Professor Candy McCabe (Nurse Consultant)
• Health Psychologist
• Occupational Therapist
• Physiotherapists
• Clinical Research Occupational Therapist and Physiotherapist
• Secretary/ Administrator
• Clinical Measurement Personnel
Our treatments include:
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Medication review and advice
Land-based physiotherapy
Hydrotherapy
Occupational therapy
Psychology
Sensory re-education (Desensitisation)
Mirror visual feedback
Graded motor imagery principles
Gait and posture re-education
Techniques to improve body perception disturbances
Acupuncture
Pain management techniques
Relaxation and stress management techniques
Strategies for improved sleep
Communication skills
Vocational rehabilitation
Patients participating in the programme gain:
• Education and knowledge about their symptoms and how to best
manage them
• Confidence in living with CRPS
• Graded goal-directed activities
• Learning self-directed strategies for home
• Meeting others with the condition
• Expertise and support in continuing treatment following the inpatient
programme
WHAT TO EXPECT FROM THE INPATIENT PROGRAMME
The inpatient programme typically lasts two weeks and patients are
engaged in individual and group therapy each working day.
On a daily basis, patients complete two hours of one-to-one supervised
therapy, which includes land-based physiotherapy, hydrotherapy and
occupational therapy. Health psychology input is provided as appropriate.
Sessions last 30 minutes and are timetabled to allow sufficient rest and
recovery between sessions. By focussing on one-to-one sessions, we are
able to tailor rehabilitation to each patient’s needs.
In addition, patients participate in group sessions run by the team covering
pain physiology, pain medications, dealing with emotions and goal setting.
Between therapy sessions, patients are encouraged to continue with
specific therapy tasks and put into practice skills in actively self-managing
their pain.
Weekend leave is encouraged, so that patients can practice their newly
learnt techniques and exercises. A detailed debrief with the patient
following the weekend enables the team to explore their achievements and
their difficulties; this enables focussed planning of their rehabilitation in the
second week.
“It felt like I was being
taken a step backwards,
but in fact I was learning
how to use my limb
properly.”
“The programme is
holistic and has
helped me to put the
routine back into my
life.”
“Well worth every
minute, but the overall
criteria when you come
in is that you have got
to be positive.”
RESEARCH
Research is an integral part of our service. We have a wide range of
projects aimed at gaining a better understanding of this complex condition.
Patients will be invited to complete questionnaires to assess various
aspects of their condition, how it affects their lives and the impact of
treatments.
Our specialist areas of interest are the mechanisms behind CRPS, the
patient’s experience of living with the condition and novel therapeutic
interventions. We have pioneered the use of a new therapy in CRPS
(Mirror Visual Feedback) which aids some people to reduce their pain
whilst exercising their affected limb.
We are supported by an in-house clinical measurement laboratory which
enables assessment of autonomic responses to interventions and altered
condition states.
Key published research includes:
Moule P, Lewis JS, McCabe CS. Designing and Delivering an Educational
Package to Meet the Needs of Primary Care Health Professionals in the
Diagnosis and Management of those with Complex Regional Pain
Syndrome. 2013; doi 10.1002/msc.1057
Lewis J, Schweinhardt P. Perceptions of the Painful Body: The Relationship
Between Body Perception Disturbance, Pain and Tactile Discrimination in
Complex Regional Pain Syndrome. European Journal of Pain, 2012; 16: 13201330.
Rodham K, Boxell E, McCabe C, Cockburn M, Waller E. Transitioning from a
Hospital Rehabilitation Programme to Home: Exploring the Experiences of
People with Complex Regional Pain Syndrome. Psychol Health, 2012; 27(10):
1150-1165.
Johnson S, Hall J, Barnett S, Draper M, Darbyshire G, Haynes L, Rooney C,
Cameron H, Moseley GL, de Williams AC, McCabe C, Goebel A. Using Graded
Motor Imagery for Complex Regional Pain Syndrome in Clinical Practice:
Failure to Improve Pain. Eur J Pain, 2012; 16(4): 550-561.
Lauder A, McCabe CS, Rodham K, Norris E. An Exploration of the Support
Person’s Perceptions and Experiences of Complex Regional Pain
Syndrome and the Rehabilitation Process. Musculoskeletal Care 2011;
9(3):169-179, 2011.
Hall J, Harrison S, Harris N, McCabe C, Blake D. Pain and Other Symptoms of
CRPS can be Increased by Ambiguous Visual Stimuli – An Exploratory
Study. Eur J Pain. 2011; 15 (1):17-22.
Lewis JS, Coales K, Hall J, McCabe CS. Now You See It, Now You Don’t.
Sensory-Motor Re-Education in Complex Regional Pain Syndrome. Hand
Therapy 2011: 16:29-38.
McCabe CS. Mirror Visual Feedback; A Practical Approach. Journal of Hand
Therapy 2011; April-June: 170-178.
Lewis J, Kersten P, McCabe CS, McPherson KM, Taylor GJ, Harris ND, Blake
DR. Wherever is My Arm? Impaired Upper Limb Position Accuracy in
Complex Regional Pain Syndrome. Pain. 2010 Jun: 149(3):463-9.
Goebel A, Baranowski A, Maurer K, Ghiai A, McCabe C, Ambler G. Intravenous
Immunoglobulin Treatment of Complex Regional Pain Syndrome: A
Randomized, Controlled Trial. Annals of Internal Medicine 2010:152:152-158
Rodham K, McCabe C, Blake D. Seeking Support: An Interpretative
Phenomenological Analysis of an Internet Message Board for People with
Complex Regional Pain Syndrome. Psychology and Health 2009: 24 (6): 619–
634.
McCabe C, Lewis J, Shenker NG, Hall J, Cohen H, Blake DR. Don’t Look Now!
Pain and Attention. Clinical Medicine 2005; 5 (5):482-486.
McCabe CS, Haigh RC, Halligan PW & Blake DR. Referred Sensations in
Complex Regional Pain Syndrome Type 1. Rheumatology, 2003: 42:10671073.
McCabe CS, Haigh RC, Ring EFR, Halligan PW, Wall PD & Blake DR. A
Controlled Pilot Study of the Utility of Mirror Visual Feedback in the
Treatment of Complex Regional Pain Syndrome (Type 1). Rheumatology
2003: 42:97-101.
USEFUL RESOURCES AND LINKS
Complex Regional Pain Syndrome Service
Royal National Hospital for Rheumatic Diseases, Bath
www.rnhrd.nhs.uk/page/79
American Patient Association for CRPS
www.rsds.org
Complex Regional Pain Syndrome - Arthritis Research UK
www.arthritisresearchuk.org/arthritis-information/conditions/
complex-regional-pain-syndrome.aspx
For further information about our Complex Regional Pain
Syndrome service and research, or for referral advice please
contact Professor Candy McCabe, Consultant Nurse, on
01225 473462 or email [email protected]
www.rnhrd.nhs.uk
Royal National Hospital for
Rheumatic Diseases
Upper Borough Walls, Bath BA1 1RL
We value your feedback. Your comments, suggestions, praise and complaints will
help us to improve the standard of our services. Please contact PALS to feedback your views on the
hospital. Tel: 01225 825656 or email [email protected]